0 


Pastoral  Medicine 

A  Handbook  for  the  Catholic  Clergy 


ALEXANDER    E.    SANFORD,   M.D 


NEW  EDITION 
REVISED,  AND  ENLARGED  BY  A  CHAPTER  ON 

THE  MOMENT  OF  DEATH 

BY 

THE    REV.    WALTER    M.    DRUM,    SJ. 

AND  BY  CHAPTERS  ON  "THE  FIFTH  COMMANDMENT" 

AND  "  NEURASTHENIA  IN  ITS  PASTORAL- 

PSYCHIATRIC  ASPECTS" 


NEW  YORK 
JOSEPH    F.  WAGNER 

r^WFTWONY'S,  SEMtNiM^L 
SANTA     BARBARA.    CAJU& 


il  45bjftat 

REMIGIUS   LAFORT,   S.T.L. 

Censor  Librorum 


imprimatur 

^.JOHN  M.  FARLEY,  D.D. 

Archbhhop  of  New    Tork 

NEW  YORK,  November  17,  1905. 


COPYRIGHT,  1905,  BY  JOSEPH  F.  WAGNER,  NBW  YORK 


CONTENTS 

A* 


PAGE 

INTRODUCTION    5 


FIRST  PART. 
HYGIENE. 

I.   AIR — GENERAL  REMARKS   11 

AIR  AS  A  CAUSE  OF  DISEASE 14 

WEATHER  AND  CLIMATE   17 

II.    SOIL  AND  DRINKING  WATER   23 

III.  NUTRITION  AND  FOOD  28 

FASTING  AND  ABSTAINING    32 

FOOD   34 

IV.  DWELLING  AND  CLOTHING   47 

CLOTHING    60 

V.   HYGIENE  OF  SCHOOLS   63 

VI.   THE  INFIRMARY   71 

VII.   DEATH — ASPHYXY — SIGNS  OF  DEATH — MANNERS  OF 

DEATH — BURIAL    74 


SECOND  PART. 
PASTORAL  MEDICINE 

THE  RELATION  OF  MAN  IN  His  BODILY  CONDITIONS 

TO  RELIGION  AND  MORALITY  87 

I.   PROCURATIO   ABORTUS    88 

II.    BIRTH,  CARE  OF  THE  CHILD  92 

THE  CHILD  AT  SCHOOL  AGE  97 

III.   MATRIMONY    98 

IMPEDIMENTUM  CONSANGUINITATIS    99 

IV.   CELIBACY    101 


PAGE 

MAN  IN   SICKNESS 107 

I.    SOMATIC   DISEASES    108 

TUBERCULOSIS    117 

DIPHTHEBIA    118 

CHOLERA    119 

CHILDBED  FEVER    120 

APOPLEXY    121 

DISEASES  OF  THE  RESPIRATORY  ORGANS 122 

DISORDERS  OF  THE  HEART 123 

ABDOMINAL   DISEASES    123 

ACCIDENTS  124 

II.   MENTAL  DISEASES    124 

MELANCHOLY    132 

MANIA    134 

RAVING  MADNESS    135 

MORBIDITY  OF  IMAGINATION  135 

NERVOUS  DISORDERS   141 

EPILEPSY   141 

HYSTERIA    144 

III.  DISEASES  DUE  TO  OCCUPATIONS 149 

IV.  HYPNOSIS  AND  SUGGESTION   155 

V.    ALCOHOLISM   163 

VI.   MORPHINISM    172 

THIRD  PART. 

FIRST  AID  TO  THE  INJURED. 

I.   HEMORRHAGE  AND  ITS  TREATMENT   175 

II.     WOUNDS   AND   THEIR  TREATMENT 180 

III.  SPRAINS,  DISLOCATIONS,  FRACTURES 184 

IV.  ARTIFICIAL   RESPIRATION   AND   THE   TREATMENT   OF 

ASPHYXIA    187 

V.    POISONS  AND  THEIR  TREATMENT 194 

VI.    INSENSIBILITY  AND  FITS  208 

VII.   BURNS,    SCALDS,    ELECTRIC    SHOCK,    REMOVAL    OF 

FOREIGN  BODIES  FROM  EYE,  EAR,  AND  NOSE 215 

VIII.    THE  TRANSPORT  OF  SICK  AND  INJURED  219 

APPENDIX. 

THE  MOMENT  OF  DEATH,  by  the  Rev.  W.  M.  Drum,  S.J. .  223 

THE   FIFTH   COMMANDMENT    236 

NEURASTHENIA  IN  ITS  PASTORAL-PSYCHIATRIC  ASPECTS.  . . .  266 


INTRODUCTION. 

HpHE  purpose  of  Pastoral  Medicine  is  to  present  to  the 
practical  theologian  facts  of  physical  science,  as  de- 
veloped by  the  medical  profession,  for  the  purpose  of  ap- 
plying them  in  pastoral  functions  and  in  explanation  and 
support  of  the  teachings  of  faith  and  morals.  Pastoral 
Medicine  has  for  its  object  the  treatment  of  some  branches 
of  the  scope  of  pastoral  labors,  which,  as  a  rule,  are  but 
sparingly,  if  at  all,  included  in  the  clerical  student's  plan 
of  studies. 

In  the  intimate  connection  between  body  and  soul,  it 
seems  necessary  that  the  clergyman  should  have  some 
knowledge  of  the  conditions  of  the  body,  if  he  wishes  to 
fill  with  best  results  the  office  of  administrator  to  the  soul. 
He  requires  this  knowledge,  furthermore,  for  the  purpose 
of  applying  it  to  the  proper  care  of  his  own  body,  and  also 
to  enable  him  to  render  judicious  advice  and  practical  as- 
sistance in  cases  of  serious  accident,  when  he  may  be  on 
hand  before  the  physician,  and  to  offer  counsel  in  the 
rational  treatment  of  sickness  where,  in  cases  of  emer- 
gency, a  medical  man  is  not  immediately  at  hand.  There 
must,  therefore,  be  numerous  instances  when  the  knowl- 
edge gained  from  a  course  in  Pastoral  Medicine  will  be 
applicable  to  best  advantage. 

Anthropology  is  a  science  of  modern  times.  It  teaches 
the  history  of  man,  his  origin  and  his  place  among  living 
beings,  the  structure  and  functions  of  his  body.  The 
theologian,  for  the  reasons  referred  to,  is  bound  to  be 
interested  in  the  results  of  this  field  of  research. 

The  relationship  existing  between  medicine  and  the- 
ology also  exists  between  the  former  and  the  science  of 
law.  When  applied  to  jurisprudence,  medicine  teaches 
the  aspect  and  influence  of  medical  and  physical  facts  for 


6  PASTORAL   MEDICINE. 

the  purpose  of  the  administration  of  justice.  In  both 
instances  medicine  stands  in  the  position  of  an  auxiliary 
science.  Medicine  does  not  undertake  to  render  a  verdict 
in  judicial  matters,  and  Pastoral  Medicine  does  not  decide 
in  points  of  faith  and  morals.  Its  task  is  merely  to 
furnish  material  for  the  formation  of  a  correct  judgment. 
Nor  has  Pastoral  Medicine  anything  to  do  with  the  heal- 
ing of  diseases  as  practised  by  the  medical  profession, 
though  undoubtedly  it  may  greatly  help  in  the  prevention 
of  sickness  and  in  establishing  of  proper  hygienic  con- 
ditions for  the  welfare  of  mankind. 

The  priest  is,  to  a  considerable  degree,  the  teacher  of 
the  people.  The  people,  as  experience  teaches,  turn  often 
to  the  priest  for  help  and  advice,  not  only  in  matters 
ecclesiastical,  but  also  in  questions  of  physical  welfare. 

To  be  able  to  give  the  advice  proper  in  such  instances 
the  priest  should  be  familiar,  at  least,  with  the  funda- 
mental principles  of  hygiene.  The  objection  may  be  raised 
that  hygiene  does  not  properly  belong  to  the  scope  of  Pas- 
toral Medicine,  and  that  the  necessary  knowledge  in  this 
field  might  be  obtained  from  popular  scientific  works.  If 
this  be  true,  it  is  also  true  that  works  of  this  kind  are  not 
always  readily  accessible,  and  that  for  various  reasons 
the  young  ecclesiastic  can  not  be  expected  to  take  up  ex- 
tensively this  field  of  study. 

In  this  country,  moreover,  some  knowledge  of  hygiene 
is  almost  indispensable  for  the  priest,  who,  for  instance, 
is  likely  to  be  called  upon  to  arrange  for  the  building  of 
a  school,  church,  or  other  public  edifice,  with  proper  re- 
gard for  hygienic  conditions. 

When  treating  of  any  branch  of  science  or  art  we  in- 
quire into  its  development ;  its  history.  The  development 
of  Pastoral  Medicine,  in  the  sense  as  it  is  taken  in  this 
book,  is  of  modern  date.  The  connection  between  the 


INTRODUCTION.  7 

clerical  and  medical  professions,  however,  is  as  old  as  the 
history  of  man. 

Health  is  the  highest  of  worldly  possessions.  It  is, 
therefore,  not  surprising  that  mankind,  when  deprived  of 
this  possession,  have  at  all  times  endeavored  to  regain 
health  by  all  known  and  available  means.  In  ancient 
times,  when  sickness  was  considered  solely  in  the  light  of 
punishment  from  the  deity,  the  priest,  as  mediator  between 
the  deity  and  the  mortals,  was  called  upon  to  combat  the 
affliction  by  prayers,  sacrifices,  and  conjurations.  But 
soon  the  treatment  of  physical  ills  was  made  a  profession 
and  physicians  appeared  upon  the  scene.  Among  the 
Egyptians,  the  oldest  civilized  nation,  the  science  of  medi- 
cine was  very  early  developed  by  their  priests.  Phy- 
sicians were  not  allowed  to  depart  from  established  meth- 
ods of  treatment.  Each  form  of  sickness  had  its  special 
physicians.  "  Medical  science  with  them,"  says  Hero- 
dotus, "  meant  a  physician  was  a  healer  only  of  one  par- 
ticular form  of  ailment  and  not  for  others,  and  there  were 
plenty,  and  for  all  kinds  of  diseases.  They  had  physicians 
for  the  eyes,  for  the  head,  for  the  teeth,  for  the  stomach, 
and  for  other  diseases."  Egyptian  physicians  gained  con- 
siderable reputation  not  only  at  home,  but  also  in  foreign 
countries,  until  the  physicians  of  Greece  proved  to  be  their 
superiors.  The  most  renowned  among  Greek  physicians 
was  Hippocrates,  460-364  B.  C.  It  was  he  who  first  taught 
the  observation  of  nature,  the  study  and  examination  of 
the  sick  person.  He  also  wrote  books  on  medical  and 
hygienic  subjects.  Soon  after  him  philosophy  regained 
the  upper  hand  and  medicine  walked  hand  in  hand  with 
the  systems  and  theories  of  the  philosophers.  Finally  the 
science  of  medicine  sank  so  low  that  in  Greece  as  well  as  in 
Rome  its  practice  was  left  to  slaves. 

We  must  linger  for  a  moment  with  the  Israelites. 


8  PASTORAL   MEDICINE. 

Among  the  chosen  people  priests  and  Levites  possessed 
much  medical  knowledge.  It  was  their  duty  to  pass  judg- 
ment upon  the  cause  and  healing  of  leprosy,  to  undertake 
the  religious  treatment  for  the  purification  of  women  after 
childbirth,  and  to  watch  over  the  proper  observance  of 
the  rules  and  regulations  prescribed  by  the  health  authori- 
ties. 

The  Israelites  very  early  had  also  a  lay  medical  pro- 
fession, who  took  payment  for  their  services :  "  If  men 
quarrel,  and  the  one  strike  his  neighbor  with  a  stone,  or 
with  his  fist,  and  he  die  not,  but  keepeth  his  bed :  if  he  rise 
again  and  walk  abroad  upon  his  staff,  he  that  struck  him 
shall  be  quit,  yet  so  that  he  make  restitution  for  his  work, 
and  for  his  expenses  upon  the  physicians"  (Exod.  xxi. 

18,  19)- 

Let  us  now  throw  a  glance  upon  the  conditions  existing 
at  the  time  when  Christianity  appeared  upon  the  scene. 
The  Lord  Himself  performed  many  wonderful  cures  upon 
the  afflicted,  and  always  exercised  His  charity  upon  the 
sick  and  the  weak.  The  first  Christians,  from  the  bishop 
down  to  the  new  convert,  vied  in  their  efforts  to  follow 
His  example  in  taking  care  of  the  sick,  the  helpless,  and 
the  victims  of  persecutions. 

As  soon  as  Christianity  was  allowed  a  free  field,  there 
arose  before  the  eyes  of  astonished  heathenism  an  activity 
of  Christian  charity.  There  rose  up  in  all  large  cities 
hospitals,  where  the  sick  were  taken  care  of  and  the  pil- 
grims found  a  home.  Many  holy  Fathers,  such  as  St. 
Basil,  St.  Ambrose,  and  St.  Augustine,  were  founders  of 
such  institutions. 

Medicine  was  practised  in  the  spirit  of  Christian  charity 
by  clerics  and  monks.  (J.  Chrys.  de  Sacerdot.  L.  3,  c.  6.) 
The  Augustinian  monks  were  particularly  renowned  for 
their  knowledge  and  skill  in  medicine.  Also  the  Benedic- 


INTRODUCTION.  9 

tines  of  Monte  Cassino  practised  medicine  according  to 
the  doctrines  of  Hippocrates  and  Galenus.  To  these  zeal- 
ous clerical  physicians  we  owe  the  preservation  of  many 
ancient  manuscripts  on  medical  science  and  practice,  as 
the  works  of  Hippocrates,  Galenus,  Celsius,  and  others. 

In  the  early  Middle  Ages  medicine  was  a  favorite  study 
of  numerous  ecclesiastics.  Many  of  them  made  practical 
application  of  the  results  of  their  studies  in  convent,  mon- 
astery, and  at  the  sickbed,  and  as  a  consequence  the  pur- 
suit of  this  work  brought  some  of  them  into  conflict  with 
the  dignity  of  their  office. 

Referring  to  this  state  of  affairs  the  Cistercian  monk 
Helinand  (1227)  complains:  " Ecce  quaerunt  clerici 
Parisiis  artes  liberates,  Aureliani  auctores,  Bononiae 
codices,  Salerni  pyxides,  Toleti  daemones  et  nusquam 
mores." 

We  must  not  omit  to  mention  the  celebrated  medical 
school  of  Salerno,  where  Greek,  Roman,  and  even  Arabian 
doctors  obtained  their  knowledge.  Desiderius,  Abbot  of 
Monte  Cassino,  who  later  became  Pope  Victor  III.,  was  a 
physician  and  instructor  at  this  school  toward  the  end  of 
the  eleventh  century. 

Digressions  from  studies  proper  to  their  vocation,  by 
priests,  finally  caused  the  Church  to  proceed  in  a  dis- 
ciplinary manner.  The  council  of  Rheims  (1131)  forbade 
monks  and  priests  to  study  and  practise  medicine  for  the 
purpose  of  revenue.  Two  councils  at  Montpellier  (1162 
and  1195)  made  this  interdiction  more  severe.  In  the 
Decrt.  Greg.  lib.  iii.,  tit.  4,  we  read,  "  Sententiam  san- 
guinis  nullus  clericus  dictet  out  proferat,  nullus  quoque 
clericus  ruptariis  vel  ballistariis  aut  hujusmodi  viris  san- 
guinum  praeponatur,  nee  ullam  chirurgiae  artem,  Sub- 
diaconus,  Diaconus,  vel  Sacerdos  exerceat,  quae  adus- 
tionem  vel  incisionem  inducit." 


io  PASTORAL  MEDICINE. 

Pope  Innocent  III.,  at  the  General  Council  of  1215,  con- 
firmed the  prohibition  of  the  practice  of  chirurgy  by  monks 
and  clerics.  A  further  proceeding,  partly  caused  by  the 
clerical  occupation  with  medicine,  is  taken  in  the  well 
known  bull  of  Boniface  VIII.  (1300),  in  which  excom- 
munication is  pronounced  upon  all  those  who  undertook 
the  dissection  of  a  human  body  or  the  boiling  of  human 
bones.  On  account  of  these  and  similar  severe  measures, 
clerical  physicians  gradually  became  extinct. 

Notwithstanding  these  misemployments,  it  was  at  all 
times  a  recognized  fact  that  the  ecclesiastic  who  devotes 
his  work  to  the  care  of  the  soul,  should  take  into  considera- 
tion its  habitation:  the  body,  and,  consequently,  should 
not  be  without  certain  amount  of  medical  knowledge. 

It  is  not  the  purpose  of  Pastoral  Medicine  to  teach  or 
to  induce  the  priest  to  take  upon  himself  the  task  of  the 
practising  physician ;  it  merely  undertakes  to  enable  him 
to  advise  and  caution,  to  protect  by  hygienic  and  dietetic 
measures,  himself  and  his  flock  against  disease. 


FIRST    PART. 
HYGIENE. 

TT  YGIENE  is  that  branch  of  medical  science  which  oc- 
•*•  •*  cupies  itself  with  the  preservation  and  furtherance 
of  health  and  sanitary  conditions.  In  our  own  days 
hygiene  has  received  considerable  attention  and  advance- 
ment. It  is  clearly  the  fact  that  the  prevention  of  sick- 
ness is  more  easily  accomplished  than  its  cure.  Therefore 
great  attention  to  this  matter  is  being  paid  in  all  well 
regulated  communities.  England  took  the  lead  over  all 
other  countries  in  the  diffusion  of  knowledge  concerning 
hygienic  conditions.  Disraeli  (Lord  Beaconsfield)  at  a 
meeting  in  Manchester  (England)  maintained  the  import- 
ance of  hygiene  in  the  following  language :  "  In  my  opin- 
ion, the  establishing  of  sanitary  conditions  among  our  peo- 
ple is  the  one  social  question  which  stands  above  all  others 
and  which  must  command  the  primary  attention  of  all 
statesmen  and  politicians  irrespective  of  party.  By  pro- 
viding wholesome  habitations,  pure  drinking  water,  un- 
adulterated food,  and  pure  air  we  shall  be  enabled  to 
secure  the  happiness  and  welfare  of  our  people." 

I. — AIR. 
i. — General  Remarks. 

The  7one  of  gas  which  enwraps  our  terrestrial  globe, 
and  which  moves  with  the  globe's  surface  around  its  axis, 
we  call  the  atmosphere.  The  layer  of  air  nearest  to  the 
earth's  surface  is  the  most  compressed,  and,  therefore,  the 
heaviest.  Farther  removed  from  the  earth  the  air  be- 
comes thinner  and  lighter.  Since  the  atmosphere  sur- 

/ 
ii 


12  PASTORAL   MEDICINE. 

rounds  all  objects  upon  the  surface  of  the  earth  uni- 
formly and  penetrates  all  vacuities,  we  do  not  feel  its 
pressure. 

The  instruments  with  which  we  measure  the  pressure 
of  the  air  are  called  barometers.  The  ordinary  mercury 
barometer  contains  in  its  sealed  long  glass  tube  a  column 
of  mercury  about  thirty  inches  long.  The  air  pressure 
upon  the  short,  open  arm  of  the  barometer  tube  prevents 
the  mercury  from  flowing  out.  If  water  were  to  be  sub- 
stituted for  mercury,  the  column  of  water  to  hold  the  bal- 
ance with  the  pressure  of  air  would  be  greater  in  propor- 
tion as  water  is  lighter  than  mercury.  Putting  the  specific 
weight  of  water  at  =  I,  that  of  mercury  will  be  13.59.  By 
a  simple  computation  we  will  find  that  the  height  of  the 
column  of  water  would  have  to  be  about  36  feet.  In  other 
words,  air  pressure  will  raise  water  about  36  feet.  (As 
demonstrated  in  an  ordinary  pump.)  We  further  learn 
from  these  physical  laws  that  the  atmospheric  air  of  ^ 
square  inch  has  a  pressure  of  about  2.27  pounds.  The 
force  of  atmospheric  pressure  diminishes  with  increas- 
ing elevation  above  the  level  of  the  sea.  At  an  elevation 
of  17,000  feet  the  barometer  will  indicate  hardly  half  the 
pressure  that  it  will  show  at  sea  level. 

Besides  the  mercury  barometer,  there  are  also  used 
metal  or  aneroid  barometers  for  the  measurement  of  air 
pressure.  The  action  of  aneroid  barometers  depends  on 
the  varying  pressure  of  the  atmosphere  upon  the  elastic 
top  of  a  metallic  box  (shaped  like  a  watch)  from  which 
the  air  has  been  exhausted.  An  index  shows  the  varia- 
tion of  pressure.  Though  as  regards  the  handier  form, 
the  greater  durability  and  convenient  carrying  the  aneroid 
barometer  are  preferable,  yet  it  remains  necessary  for  the 
purpose  of  correct  measurements  to  compare  it  with  the 
mercury  barometer. 


AIR.  13 

The  temperature  of  the  air  is  ascertained  by  therr 
mometers. 

Atmospheric  air,  the  prime  necessity  of  all  organic  life 
upon  earthj  has  been  shown  to  be  essentially  a  mixture 
of  nitrogen  (79%),  oxygen  (20.96%),  carbon  dioxide 
(0.04%),  some  vapor  of  water  and  traces  of  ozone.  This 
mixture  is  considered  the  pure,  wholesome  air,  and  re- 
mains nearly  always  the  same  under  normal  conditions. 
Of  these  component  gaseous  substances  nitrogen  is  the 
least  important  in  relation  to  hygienic  considerations.  It 
has  no  functions  in  the  animal  body  and  is  merely  a 
medium  for  diluting  the  oxygen.  Oxygen  is  the  gas  in- 
dispensable for  breathing  and,  therefore,  for  life.  With 
each  respiration  oxygen  mixes  with  the  blood  in  the  lung- 
cells  and  makes  it  bright  red,  arterial.  The  arterial 
stream  of  blood  charged  with  oxygen  penetrates  into  all, 
even  the  most  remote  parts  of  the  body,  and  is  active  in 
all  functions  of  life. 

Ozone  is  a  peculiar  modification  of  oxygen.  The  most 
remarkable  property  of  this  agent  is  its  oxidizing  power. 
Pigments  are  easily  destroyed  by  ozone,  metals  rust  under 
its  influence,  moreover  organic  corpuscles  of  all  kinds, 
contained  in  dust,  in  the  air,  as  well  as  disease  germs,  are 
all  oxidized  and  thereby  rendered  innocuous.  Just  as  sure 
as  you  will  find  ozone  in  a  fragrant  pine  forest,  you  will 
look  for  it  in  vain  in  the  lanes  of  manufacturing  towns  or 
in  crowded  habitations. 

Of  the  greatest  influence  upon  hygienic  conditions  is 
the  percentage  of  carbon  dioxide  in  the  air. 

The  principal  cause  for  the  existence  of  carbon  dioxide 
is  the  respiration  of  human  beings  and  animals.  As  ex- 
plained above,  oxygen  enters  into  the  blood  with  the  air 
which  we  take  into  our  lungs  through  the  action  of  breath- 
ing, At  the  same  time  we  expel  in  the  reverse  action  of 


i4  PASTORAL   MEDICINE. 

the  respiratory  organs  air  laden  with  carbon  dioxide.  An 
adult  emits  by  respiration  carbon  dioxide  to  the  extent  of 
about  25  quarts  hourly. 

A  second  cause  for  the  presence  of  atmospheric  carbon 
dioxide  is  the  process  of  decomposition  and  decay,  which 
takes  place  especially  in  manure  and  fertilized  soil. 

In  the  third  place,  the  consumption  of  fuel  in  industrial 
centres  furnishes  a  great  amount  of  carbon  dioxide.  Fi- 
nally there  are  subterranean  stores  of  carbon  dioxide  which 
feed  the  atmosphere  through  the  fissures  of  rocks  and 
volcanoes. 

This  ceaseless  supply  of  carbon  dioxide  is  counter- 
balanced by  a  proportionate  absorption.  In  regard  to 
this  point  we  must  mention,  first,  the  wonderful  inter- 
change between  the  animal  and  vegetable  kingdoms.  Green 
plants  consume  in  daylight  carbon  dioxide,  applying  the 
same  for  the  building  of  cells. 

Atmospheric  precipitations  (rain)  also  absorb  carbon 
dioxide,  and,  lastly,  carbon  dioxide  is  removed  by  the  acids 
of  salt  water  and  by  dispersing  winds.  The  result  is,  that 
we  find,  as  a  rule,  an  equal  percentage  of  carbon  dioxide  in 
the  atmosphere  (0.03-0.04%) 

1. — Air  as  a  Cause  of  Disease. 

Experience  teaches  that  air  in  the  open,  containing 
0.05%  of  carbon  dioxide,  as  is  often  the  case  in  industrial 
centres,  is  hard  to  breathe  for  a  length  of  time.  In  rooms 
air  must  be  considered  as  bad  and  unfit  for  a  continued 
stay  for  human  beings,  which,  as  a  consequence  of  the 
breathing  process  of  its  occupants,  contains  more  than 
0.10%  of  carbon  dioxide.  To  many  people  even  a  short 
stay  in  such  rooms  causes  headaches,  dizziness,  or  nausea. 
A  continued  stay  in  such  rooms  will  cause  poorness  of 
blood  and  inclination  to  lung  diseases.  Good  air  in  living 


AIR  AS  A  CAUSE  OF  DISEASE.  15 

rooms,  such  as  not  to  impair  health,  must  not  contain 
more  than  0.07%  of  carbon  dioxide. 

The  clergyman  in  his  everyday  life  comes  into  frequent 
contact  with  air  in  closed  rooms  where  many  persons  are 
breathing,  such  as  churches,  schoolrooms,  and  meeting 
rooms. 

It  is,  therefore,  necessary  that  such  rooms,  after  having 
been  vacated,  be  properly  aired,  and  that  free  access 
should  be  given  to  the  outer  air  while  the  rooms  are  oc- 
cupied. In  closed  rooms,  where  many  people  congregate, 
and  where  fresh  air  is  prevented  from  entering,  there 
soon  arises  an  unwholesome  condition  not  only  by  over- 
charge of  carbon  dioxide,  but  also  by  excretion  of  the  skin 
and  the  nature  of  the  exhalation.  The  nose  in  normal  con- 
dition is  the  best  agent  to  discover  such  conditions. 
Apart  from  the  danger  from  gaseous  substances,  the  air 
may  also  cause  disease  by  being  charged  with  dust  and 
bacteria. 

In  our  towns  the  atmosphere  is  greatly  defiled  by 
the  enormous  mass  of  soot  emitted  from  flues  and  chim- 
neys. Smoke  and  soot  consist  of  dense  masses  of 
carbon  dioxide  mixed  with  small  particles  of  coal,  which 
escape  into  the  flue  from  the  flames  on  account  of  incom- 
plete combustion. 

In  industrial  centres  this  admixture  becomes  so  con- 
siderable as  to  make  the  air  detrimental  to  the  state  of 
general  health.  Inflammation  of  the  lungs  often  takes 
a  fatal  turn  under  such  conditions.  These  impurities  of 
the  air  are  particularly  injurious  to  those  whose  respira- 
tory organs  are  delicate  or  already  affected.  Such  indi- 
viduals should,  if  possible,  change  their  place  of  abode. 
Especially  the  clergyman  whose  lungs  are  subjected  to 
a  great  strain  in  the  discharge  of  his  duties  should  be 
careful,  where  such  conditions  prevail. 


16  PASTORAL   MEDICINE. 

Microscopic  growths,  called  bacteria,  which  in  our  time 
have  been  discovered  to  be  the  cause  of  infectious  diseases, 
form  a  very  considerable  part  of  the  impurity  of  the  air. 
These  microorganisms  stick  to  mineral  dust  particles  and 
to  minute  fragments  from  clothing  fabrics  mixed  with 
the  air. 

It  has  been  known  for  some  time  that  the  agents  which 
cause  fermentation  and  decomposition  are  also  micro- 
organisms. If  the  development  of  these  microorganisms 
is  checked  by  the  introduction  of  substances  which  are 
poison  to  them,  then  decomposition  does  not  occur.  These 
bacteria  destroyers  are  known  as  conserving  or  antiseptic 
agents.  The  best  known  of  them  are  carbolic  acid,  acetic 
acid,  sublimate,  salt  in  large  quantities,  etc.  The  careful 
and  proper  employment  of  such  antiseptic  agents  serves 
to  preserve  articles  of  food  in  daily  life.  We  stated  above 
that  bacteria  are  the  origin  and  cause  of  contagious 
diseases.  If  a  wound,  infected  with  microorganisms  or 
bacteria,  as  is  the  case  with  wounds  due  to  accident,  is 
treated  with  such  antiseptic  agents,  festering  of  the 
wound  and  feverish  conditions  may  be  avoided.  If  not  so 
treated  suppuration  and  fever  are  the  consequences.  These 
malignant  results  of  infection  may  also  be  avoided  by  the 
use  of  sanitary  bandages  after  the  wound  has  been 
properly  cleansed  and  disinfected.  The  bandages  will  filter 
the  air  before  it  reaches  the  wound.  Upon  these  principles 
rests  the  modern  antiseptic  treatment  of  wounds. 

The  least  number  of  microorganisms  are  found  in  the 
air  of  the  open  country,  entirely  or  almost  free  from  hu- 
man habitation,  on  high  mountains,  and  also  on  the  sea 
a  distance  from  the  shore.  But  even  in  populous  districts 
the  constant  motion  of  the  air  causes  such  a  dispersion 
of  infectious  microorganisms  that  the  danger  of  catching 
disease  by  mere  contact  of  air  is  only  remote. 


WEATHER  AND  CLIMATE.  17 

The  deposition  of  these  infectious  microorganisms  by 
the  air  is  various.  In  the  quiet  air  of  the  sick-room  they 
settle  upon  the  floor  and  the  furniture.  Infection  by  con- 
tact with  air  in  the  sick-room  would  be  made  more  likely 
if  dust  was  there  allowed  to  gather,  which  through  the 
moving  about  of  patients,  or  through  handling  of  beds, 
clothes,  or  furniture  would  rise  and  through  inhalation 
enter  the  systems  of  those  present. 

3. — Weather  and  Climate. 

The  physical  processes  in  the  atmosphere  produced 
by  passing  changes  in  temperature,  air  pressure,  and 
lower  or  greater  humidity  of  the  air  we  call  weather. 

By  climate  we  understand  the  average  condition  of  a 
certain  territory  in  regard  to  temperature,  moisture,  etc. 

Weather  and  climate  have  always  had  a  great  influence 
upon  the  state  of  human  health.  Daily  experience  teaches, 
for  instance,  the  influence  of  weather  and  climate  upon 
catarrhal,  pulmonary,  rheumatic,  digestive,  and  nervous 
ailments.  We  also  know  the  healing  power  of  some  cli- 
mates for  certain  diseases,  for  instance,  of  the  mountain 
air  for  consumption.  On  the  other  hand,  it  must  be  men- 
tioned that  the  benefit  of  climatic  conditions  is  often 
greatly  exaggerated  for  commercial  purposes. 

Let  us  now  consider  what  connection  there  is  between 
the  temperature  of  the  air  and  the  state  of  our  health. 
The  human  body,  by  the  functions  of  life,  produces 
warmth.  For  the  purpose  of  health  the  own  warmth  of  the 
body  must  not  be  below  a  certain  degree.  The  blood 
heat  of  a  healthy  person  is  about  98°  Fahrenheit.  This 
warmth,  produced  by  functions  of  the  body,  digesting  of 
food,  muscle  and  nerve  activity,  etc.,  is  counterbalanced 
by  certain  causes  of  decrement,  such  as  exudation,  ab- 
sorption by  contact  with  cold  objects,  etc. 


i8  PASTORAL   MEDICINE. 

The  natural  factors  producing  warmth  of  the  body  are 
not  always  sufficient  to  keep  it  in  normal  condition.  For 
this  purpose  clothing  and  dwelling  are  needed. 

Excessive  heat  of  the  air  causes  an  accumulation  of 
heat  in  the  body,  which  may  call  forth  dangerous  and 
sometimes  acute  manifestations  of  health  disturbances,  as 
observed  in  cases  of  heat  prostration  and  sunstroke. 
In  the  first  stage  of  heat  prostration  the  face  has  a 
flushed  appearance,  the  eyes  are  glassy;  headache,  dry- 
ness  of  skin,  a  burning  sensation  in  the  throat  and 
hoarseness  make  their  appearance.  Soon  dizziness,  rapid 
action  of  the  heart,  trembling  and  fainting  follow,  until 
finally  the  afflicted  collapses  completely. 

Treatment  for  persons  prostrated  from  heat  is  as  fol- 
lows. Such  a  person  should  be  taken  quickly  to  an  airy, 
cool  place;  tight  clothing  should  be  removed;  face  and 
head  freely  washed  and  cooled  with  cold  water  and  ice 
bandages ;  refreshing  and  strengthening  drink  should  be 
sparingly  given.  In  serious  cases,  medical  aid  must  im- 
mediately be  summoned,  because  treatment  will  differ 
according  to  individual  conditions. 

It  should  be  remembered  that  for  the  production 
of  heat-prostration  the  high  temperature  of  the  air  alone 
is  not  decisive.  In  dry  and  breezy  air,  no  matter  how 
high  the  temperature,  or  where  abundant  perspiration  is 
obtained  (Turkish  or  Russian  baths),  prostration  will  not 
result  from  great  heat.  It  is  most  likely  to  happen  in 
calm  air  of  high  temperature  charged  with  a  great  amount 
of  humidity,  especially  in  a  prolonged  term  of  such  wea- 
ther. Such  conditions  are  met  with  in  the  tropics,  at 
the  beginning  of  the  rainy  season,  and  also  in  some 
moderate  climates  during  summer  time. 

The  crowding  of  human  beings  in  closed  rooms,  such  as 
churches,  classrooms,  etc.,  is  conducive  to  heat  prostra- 


WEATHER  AND  CLIMATE.  19 

tion,  which,  under  such  conditions,  often  appears  in  form 
of  fainting  spells.  Light  airy  clothing,  avoidance  of 
strenuous  exercise,  the  free  drinking  of  pure  water  and 
other  wholesome  beverages,  with  absolute  exclusion  of  all 
alcoholic  liquids,  are  the  best  preventives  against  heat 
prostration. 

Sunstroke,  properly  so  called,  differs  from  ordinary 
heat  prostration  by  the  fact  that  it  is  directly  caused 
by  the  rays  of  the  sun.  It  occurs  in  the  tropics,  and  to 
guard  against  it  travelers  in  those  parts  usually  wear 
light,  porous  cork  helmets,  to  which  a  linen  cloth,  pro- 
tecting the  neck,  is  fastened. 

Besides  these  forms  of  disease  directly  due  to  high 
atmospheric  temperature,  there  are  others  indirectly 
caused  by  the  latter;  for  instance,  cholera  morbus,  which 
affects  the  digestive  organs  and  results  not  infrequently 
in  death,  especially  among  children.  It  is  advisable  to  call 
in  a  physician  for  this  ailment. 

Regarding  hygiene  for  hot  days,  Dr.  Brouardel,  hon- 
orary dean  of  the  Paris  faculty  and  former  president  of 
the  Consulting  Committee  of  Public  Hygiene,  has  issued 
certain  counsels  of  dietetic  prudence  for  the  dog  days 
which  may  not  be  without  their  interest  for  American 
readers.  He  advises  a  sufficiency  of  solid  food,  with  light 
vegetables,  not  highly  seasoned,  and  avoiding  fats  and 
farinaceous  diet.  In  liquids  he  urges  hot  as  against  cold 
drinks,  and  especially  tea  or  coffee.  If,  however,  cold 
drinks  are  insisted  upon,  coffee,  wine  diluted  with  water, 
and  lemonade  are  best.  Ice  and  alcohol  are  both  tabooed. 
Apparently  all  the  doctors  in  Paris  were  engaged  in  giv- 
ing their  views  of  "  what  to  eat,  drink,  and  avoid  "  during 
the  heat  wave.  The  opinions  are  various,  but  when  they 
are  collated,  it  is  possible  to  arrive  at  some  general  con- 
clusion. Lean  meat — not  much  of  it — fresh  vegetables, 


20  PASTORAL   MEDICINE. 

tea  and  coffee  in  any  quantities,  but  no  spirits  on  any  pre- 
tence, as  few  iced  drinks  and  as  little  alcohol  generally  as 
possible,  seem  to  be  about  the  regimen  favored  by  the 
French  medical  men  during  hot  weather,  and  common 
sense  supports  it. 

The  influence  of  low  temperature  upon  the  human  body 
is,  as  a  rule,  without  injurious  consequences,  if  the  body 
is  properly  protected  and  cared  for.  If  this,  however, 
is  not  the  case,  very  low  temperature  may  cause  directly 
serious  disturbances  of  health.  Extremities  become  frost- 
bitten and  gangrenous.  In  more  aggravated  cases  the 
blood  is  forced  into  the  brain  and  lungs,  causing  headache 
and  difficulty  of  breathing.  In  the  extreme  stages  of 
freezing  there  follow  unconsciousness  and  death  by 
paralysis  of  the  vital  organs.  It  is  commonly  known 
that  frozen  parts  of  the  body  must  not  be  treated  in 
warm  rooms  and  by  warm  applications,  but  by  rubbing 
with  snow  and  ice  water,  in  a  cool  place. 

Ordinary  variations  of  air  pressure  have  not,  as  a 
rule,  a  direct  influence  upon  human  health.  Indirectly 
these  variations  are  of  consequence,  because  upon  them 
depend  winds  and  precipitations,  and  the  latter  are  in 
many  ways  the  cause  of  disturbances  of  health,  such  as 
colds,  etc. 

Artificially  increased  air  pressure,  such  as  found  in 
pneumatic  caissons  and  in  other  apparatus  used  in  bridge 
building,  etc.,  causes  a  retarding  and  deepening  of  respira- 
tion ;  the  blood  is  driven  from  the  periphery  to  the  inner 
organs  of  the  body,  and  the  hearing,  speaking,  and  use  of 
muscle  are  greatly  impaired.  The  change  from  com- 
pressed to  ordinary  air  should  be  very  carefully  made, 
as  bleeding  from  nose  and  lungs  may  ensue,  and  even 
sudden  death  may  result. 

Diminished  air  pressure,  as  met  with  in  high  altitudes, 


WEATHER  AND  CLIMATE.  21 

causes  acceleration  of  respiration  and  pulse.  In  dimin- 
ished air  pressure  in  higher  altitudes  veins  near  the 
surface  of  the  skin,  for  instance,  of  the  nose,  lips,  and 
gums,  may  burst  and  cause  bleeding  of  those  parts.  In  very 
high  altitudes  dryness  of  the  throat,  difficulty  in  swallow- 
ing, thirst,  dizziness,  and  headache  are  liable  to  occur. 
These  diseased  conditions  are  mostly  observed  in  indi- 
viduals not  used  to  the  living  in  high  altitudes,  and  are 
generally  called  mountain  sickness. 

The  variable  humidity  of  the  air  has  an  influence  upon 
our  health,  especially  in  connection  with  high  temperature. 
The  danger  resulting  from  this  connection  has  been 
demonstrated  in  our  remarks  on  heat  prostration.  Moist, 
cold  air  is  a  powerful  heat  conductor,  and  takes  much  heat 
from  the  body.  From  this  fact  arises  the  uncomfortable 
feeling  which  we  experience  in  air  of  that  kind.  In  new 
buildings,  not  thoroughly  dried,  there  is  present  a  damp, 
cold  air,  causing  rheumatism  and  diseases  of  the  respira- 
tory organs  and  kidneys. 

Mentioning  briefly  the  sanitary  aspect  of  the  various 
climates  of  the  earth,  we  have  to  state  that  the  climate  in 
the  polar  regions  is  subjected  to  pronounced  changes  in 
accordance  with  the  seasons  of  the  year.  During  the  win- 
ter the  sun's  rays  are  entirely  absent ;  extreme  cold  pre- 
vails. Toward  May  the  temperature  rises,  and  attains  its 
greatest  warmth  during  July  and  August.  Winter,  with 
its  death-like  numbness  of  nature,  its  dreadful  monotony, 
in  connection  with  the  prevailing  dusk,  produces,  accord- 
ing to  polar  travelers,  in  most  human  beings  an  apathetic 
feeling  and  great  depression  of  mind.  Where  a  variety  of 
food  is  lacking  scurvy  is  of  frequent  occurrence — a  sick- 
ness always  accompanied  by  decomposition  of  the  blood. 
Otherwise  the  sanitary  conditions  are  comparatively 
favorable.  Pulmonary  consumption  is  hardly  ever  found 


22  PASTORAL   MEDICINE. 

in  Iceland,  the  Faroe  Islands,  and  the  northern  part  of 
Norway.  Malignant  diseases  of  the  bowels  and  inter- 
mittent fever  are  almost  unknown. 

The  climate  of  the  temperate  zone  is,  as  a  rule,  free 
from  excessive  heat  and  a  great  degree  of  cold  in  its 
regular  change  of  seasons.  A  difference  must  be  made 
there,  however,  between  the  inland  climate  and  the  climate 
of  the  coast.  There  are  also  various  conditions  that  have 
influence  upon  the  climate  of  parts  in  the  temperate  zone, 
so  that  it  greatly  varies. 

The  tropical  climate  is  distinguished  by  the  regularity 
of  its  seasons.  They  do  not  differ  there  so  much  in  de- 
grees of  temperature,  but  rather  by  conditions  of  drought, 
wind  and  precipitation  (the  rainy  season). 

The  sanitary  conditions  of  tropical  regions  are  of  in- 
creased interest  to  our  clerics  on  account  of  the  fact  that 
a  great  number  of  their  brethren  are  active  as  missionaries 
in  tropical  countries. 

The  prevalent  diseases  of  the  tropics  are  tropical 
anemia,  diarrhea,  dysentery,  intermittent  fever,  and 
malaria.  The  latter  is  a  most  dangerous  malady  in  trop- 
ical regions.  The  name  itself,  mal-aria  (bad  air),  stamps 
the  sickness  as  the  product  of  the  surrounding  atmosphere. 
This  bad  air  producing  malaria  is  principally  found  in 
marshy  grounds,  low-lying  river  banks,  and  the  mouths 
of  rivers  with  brackish  water.  In  spite  of  all  dangers 
from  the  hot  climate,  there  are  found  among  northern  peo- 
ple many  individuals  who  successfully  and  continuously 
overcome  these  conditions.  Lean,  but  healthy,  men  of 
normal  quantity  and  quality  of  blood  will,  in  the  tropics, 
have  the  advantage  over  bloodless,  inflated,  fleshy  and 
freely  perspiring  individuals. 


SOIL   AND   DRINKING    WATER.  23 


II. — SOIL  AND  DRINKING  WATER. 

The  soil,  on  which  the  human  being  lives,  has  a  direct 
bearing  upon  the  condition  of  the  health. 

It  has  at  all  times  been  a  well  known  fact  that  cer- 
tain localities  have,  for  instance,  been  particularly  favor- 
able to  the  development  of  malaria.  As  shown  before, 
these  conditions  always  exist  where  stagnant  water 
gathers  on  the  surface  of  the  ground,  and  where  at  the 
same  time  decaying  organic,  especially  vegetable,  matter 
is  deposited.  By  the  process  of  decomposition  there  are 
formed  several  kinds  of  gases  which,  heavier  than  the 
atmosphere,  remain  resting  upon  the  surface.  In  such 
districts,  it  is,  therefore,  especially  dangerous  to  lie  down 
upon  the  ground  to  rest  or  to  sleep.  Intermittent  fever 
is  almost  sure  to  be  the  result.  A  person  resting  on  or 
near  such  ground  is  also  exposed  to  the  danger  of  being 
inoculated  with  malaria  germs  by  the  sting  of  insects.  The 
health  menacing  condition  of  malarial  soil  may  be  amelio- 
rated by  drainage. 

The  mechanical  properties  of  certain  soil  (clay  and 
sand)  have  a  faculty  of  absorbing  and  burying  decom- 
posed matter.  With  this  faculty  of  the  soil  must  be  men- 
tioned another  fact,  which  plays  a  great  part  in  the  house- 
hold of  nature — it  is  the  activity  of  microorganisms  in  the 
soil.  Through  them  the  carbon  and  nitrogen  of  organic 
matter  become  mineralized,  i.  e.,  they  are  changed  into 
carbon  dioxide  and  nitric  acid.  These  again  furnish  in- 
dispensable food  for  the  vegetable  world. 

The  pores  of  the  earth's  surface  are  entirely,  or  to  some 
extent,  filled  with  air.  This  air  in  the  soil  is  a  continuation 
of  the  atmosphere,  although  it  shows  in  its  chemical  com- 
position a  difference  from  atmospheric  air.  The  air  in 


24  PASTORAL   MEDICINE. 

the  ground  is  mixed  with  aqueous  vapors;  it  contains 
larger  quantities  of  carbon  dioxide  than  atmospheric  air 
and  less  oxygen. 

In  deep  wells,  in  burial  vaults,  etc.,  there  occurs  some- 
times a  dangerous  accumulation  of  carbon  dioxide  gases, 
which,  upon  sudden,  incautious  entering,  cause  poisoning. 
The  best  means  for  finding  out  whether  a  sufficient 
amount  of  breathing  air  is  present  in  vaults,  etc.,  is  the 
lowering  of  a  burning  light.  If  the  light  dies  away,  it 
will  be  dangerous  to  go  down  without  previously  intro- 
ducing a  sufficient  amount  of  fresh  air.  In  sewers,  tan- 
pits,  and  similar  places,  there  is  often  present  besides  the 
carbon  dioxide  an  accumulation  of  poisonous,  sulphurated 
hydrogenic  gases.  Workmen  who  enter  such  places  in- 
cautiously sometimes  collapse,  as  if  struck  by  lightning. 

Ground  air  may  enter  dwellings  if  the  cellar  floor  is  not 
solidly  cemented.  This  transmission  becomes  more  likely 
when  the  pressure  of  the  atmospheric  air  diminishes, 
the  barometer  falls,  also  when  strong  winds  press  upon 
the  surface  of  the  earth.  The  surface  of  the  earth  cov- 
ered by  houses  is  then  not  subject  to  the  wind  pressure 
and  offers  an  escape  for  the  compressed  ground  air.  Dur- 
ing the  period  of  heating  there  is  a  further  opportunity 
for  the  entering  of  ground  gases  into  dwellings.  The  air 
in  rooms  becomes  heated,  and  also  lighter,  and  thus  allows 
the  cold  ground  air  to  rise.  This  efflux  of  ground  gases 
may  become  extremely  dangerous,  when,  owing  to  leak- 
ing pipes,  illuminating  gas  has  been  allowed  to  saturate 
the  soil.  Under  such  conditions  the  gases  penetrate  the 
dwellings,  unnoticed  by  the  occupants,  and  cause  poison- 
ing. 

Of  much  more  hygienic  interest  than  the  underground 
air  is  the  underground  water.  By  underground  water  we 
understand  those  extensive  accumulations  of  water  which 


SOIL   AND   DRINKING    WATER.  25 

constantly  fill  the  pores  and  cavities  of  the  earth.  In 
porous  soil  an  accumulation  of  water  can  only  occur  there, 
where  a  substratum  of  rock,  clay,  or  lime  prevents  the 
water  from  penetrating  into  lower  depths. 

If  underground  water  remains  at  certain  seasons  of  the 
year  near  the  surface,  it  causes  a  marshy  condition  con- 
ducive to  malaria.  If  it  rises  to  the  surface  only  tem- 
porarily it  will  endanger  the  foundations  of  dwellings, 
penetrate  into  the  basements,  and,  after  abating,  leave  an 
abnormal  moisture  of  the  air,  causing  mold  and  offensive 
odor.  If  the  underground  water,  however,  is  located  at 
too  great  a  distance  from  the  surface  of  the  earth,  there 
arises  a  difficulty  of  obtaining  water  for  drinking  and 
other  purposes. 

In  most  cases  it  is  this  underground  water  which  sup- 
plies us  with  the  indispensable  necessity  of  life,  i.  e., 
drinking  water.  If  the  underground  water  rises  and 
emerges  in  a  steady  flow  from  the  ground  it  is  called 
spring  water.  Spring  water  is,  as  a  rule,  considered  the 
best  drinking  water. 

The  geological  conditions  in  most  places  are  not  such  as 
to  cause  the  underground  water  to  emerge  from  the  sur- 
face. The  most  usual  way  of  providing  drinking  water 
is  to  sink  a  shaft  well.  The  sinking  of  a  well  is  of  the 
utmost  sanitary  importance  to  households  and  institutions. 
Before  we  state,  therefore,  the  hygienic  demands,  which 
must  be  made  upon  good  drinking  water,  we  have  to  ex- 
plain the  sanitary  principles  which  should  be  followed  in 
the  sinking  of  a  well. 

The  pure  ground  water  of  the  well  should  be  free  from 
influxes  of  all  foreign  admixtures.  To  obtain  this  it  is 
necessary  to  wall  the  well  shaft  with  solid  masonry. 

The  opening  of  the  well  at  its  surface  should  be  so  ar- 
ranged that  no  impure  water  can  flow  into  it.  For  the 


FRANCISCAN 


26  PASTORAL   MEDICINE. 

same  reason  the  top  should  be  well  covered.  A  ventila- 
tion of  the  shaft  for  the  purpose  of  maintaining  the  sa- 
lubrious quality  of  the  water  is  not  necessary.  If  the  shaft 
is  left  open  there  is  the  danger  of  all  kinds  of  injurious 
matter  falling  into  it. 

In  the  neighborhood  of  the  well  there  must  be  no  sewer- 
canals,  dung  heaps,  or  privies. 

The  question  as  to  the  distance  that  a  well  should  be 
removed  from  a  graveyard  may  sometimes  present  itself 
to  the  clergyman.  As  a  general  thing  it  is,  from  a  hy- 
gienic standpoint,  considered  necessary  to  leave  a  distance 
of  fifty  yards  between  well  and  cemetery,  particularly  if 
the  watercourse  of  the  ground  water  comes  from  the  di- 
rection of  the  latter.  The  formation  of  the  soil  into  which 
the  well  is  to  be  sunk  is  also  worthy  of  earnest  considera- 
tion if  a  cemetery  is  near.  If  the  soil  be  porous  limestone, 
then  it  is  certain  that  there  will  not  be  good  drinking 
water.  If  sunk  in  clay  perforated  with  veins  of  sand, 
these  veins  are  liable  to  carry  dangerous  matter  from  the 
cemetery  into  the  well.  It  must,  however,  be  mentioned 
that  the  danger  from  burial  places  for  ground  water  is 
often  exaggerated,  not  only  through  ignorance,  but 
in  our  times  also  for  the  purpose  of  making  propaganda 
for  cremation.  Only  to  the  above  mentioned  extent  would 
there  be  any  danger. 

In  cities  water  should  be  provided  from  a  natural  or 
artificial  reservoir  and  led  through  pipes  into  the  houses. 
This  system  of  providing  water  is  of  very  high  sanitarial 
importance,  because  the  people  are,  through  a  liberal 
supply  of  water,  induced  to  cleanliness.  Besides,  danger 
of  contagion  from  infected  water  is  removed  and  the  ref- 
use is  effectively  washed  away  through  the  sewers.  From 
an  economical  standpoint,  the  centralized  water  supply 
in  cities  has  the  advantage  of  saving  a  great  deal  of  man- 


SOIL   AND   DRINKING    WATER.  27 

ual  labor  and  making  the  extinguishing  of  fires  more 
feasible. 

If  leaden  pipes  are  used,  as  is  commonly  the  case,  there 
is  danger  of  lead  poisoning,  and  such  actually  occurs  very 
frequently.  The  danger  of  metallic  poisoning  from  drink- 
ing water  exists  particularly  where  the  pipes  are  at  times 
only  partly  filled,  and  where,  consequently,  air  has  access. 
Water  which  stands  overnight  in  the  pipes  takes  up  a  good 
deal  of  lead.  In  the  morning  this  water  should,  therefore, 
be  allowed  to  run  off  unused  before  water  for  drinking 
purposes  is  drawn  from  the  pipes.  Water  containing 
lime  or  iron  is  not  deteriorated  by  leaden  pipes. 

Finally  we  have  to  settle  the  question:  What  is  good 
drinking  water?  The  first  hygienic  condition  is  that 
drinking  water  should  not  become  a  cause  of  sickness. 

There  is  danger  of  this  when  the  water  has  a  too  high 
degree  of  hardness,  which  impairs  digestion.  Such  water 
can  not  be  used  for  cooking  many  kinds  of  food,  such  as 
pulse,  tea,  coffee,  because  of  the  indissoluble  combinations 
which  take  place  between  the  salts  of  lime  in  the  water 
and  the  ingredients  of  these  articles  of  food. 

The  hardness  of  water  is  caused  by  a  considerable  per- 
centage of  lime  and  magnesia. 

The  possibility  of  lead  poisoning  by  pipe  water  has 
been  already  mentioned.  Good  drinking  water  should 
contain  no  trace  of  lead  when  it  comes  from  the  pipes. 

Chemical  analysis  will  give  information  in  both  cases. 

Drinking  water  should  further  be,  as  far  as  possible, 
free  of  bacteria,  as  well  of  those  that  cause  decomposition 
as  of  those  which  cause  sickness.  Microscopical  as  well  as 
bacteriological  examination  carried  out  by  experts  will 
procure  the  necessary  information. 

The  second  hygienic  demand  to  be  put  to  good  drink- 
ing water  is  that  it  should  taste  well  and  be  appetizing. 


28  PASTORAL   MEDICINE. 

Water  will  be  satisfactory  if  it  is  without  smell,  colorless, 
and  clear.  Even  harmless  admixtures  to  drinking  water 
will  soon  cause  nausea  and  make  the  water  unfit  for  use. 

The  taste  of  the  water  should  be  refreshing ;  every  trace 
of  a  foul,  moldy,  and  stale  taste  must  be  absent.  These 
bad  qualities  are  often  discovered  by  the  taste  only  after 
the  water  has  been  warmed. 

The  temperature  of  good  drinking  water  should  be  from 
45°  to  55°  Fahrenheit,  throughout  the  whole  year.  Water 
of  a  higher  temperature  is  not  refreshing,  and  of  a  lower, 
injurious  to  the  channels  of  digestion. 

Finally,  good  drinking  water  should  be  obtainable  in 
sufficient  quantity.  It  is  deemed  sufficient  if  about  seventy- 
five  quarts  per  day  and  head  of  the  population  are  avail- 
able for  all  purposes.  The  minimum  for  consumption,  by 
drinking  and  the  preparation  of  food,  has  been  found  on 
ships  to  be  two  quarts  per  day  and  head, 

III. — NUTRITION  AND  FOOD. 

To  keep  our  body  in  a  healthy  condition  it  is  necessary 
to  replace  in  our  body  the  matter  absorbed  by  the  func- 
tions of  life  and  exertions  of  labor.  To  cover  the  de- 
ficiency caused  by  these  processes  we  take  foods.  Foods 
are  divided  into  two  main  groups,  nitrogenous,  or  proteid 
foods,  i.  e.,  those  which  contain  nitrogen,  and  non-nitro- 
genous, i.  e.,  those  which  do  not  contain  nitrogen. 

Nitrogenous  foods  (meat,  milk,  eggs,  pulse)  replace  the 
consumption  of  the  most  important  ingredient  of  the  body 
albumen. 

Non-nitrogenous  foods  embrace  fats  and  carbohydrates, 
collectively  called  heat  producers  or  respiratory  foods.  Fat 
is  found  in  both  the  animal  and  the  vegetable  kingdom. 
All  fat  contained  in  the  body  is  there  in  a  liquid  state. 


NUTRITION  AND   FOOD.  29 

Therefore,  only  such  fats  are  acceptable  for  nutrition 
which  become  liquid  at  a  degree  of  less  than  105°  Fahren- 
heit. Stearine,  for  instance,  is  absolutely  indigestible,  be- 
cause it  melts  only  at  a  much  higher  degree.  Carbohy- 
drates are  organic  compounds,  containing  carbon,  hy- 
drogen, and  oxygen.  They  belong  mostly  to  the  vegetable 
kingdom,  although  also  found  in  animals.  To  carbohy- 
drates belong  the  various  kinds  of  sugar  and  the  starch 
in  cereals. 

Besides  aliments,  our  body  requires  for  the  maintenance 
of  its  healthy  condition  a  supply  of  water  and  salts  in  a 
chemical  sense. 

Water  performs  in  the  household  of  the  body  a  number 
of  important  functions.  As  an  agent  of  solution  and  for 
the  moving  of  soluble  substances  it  is  of  the  greatest  im- 
portance. It  also  plays  a  great  part  in  the  regulation  of 
the  heat  of  the  body.  Our  body  needs  between  four  and 
five  pounds  of  water  every  twenty-four  hours,  supplied 
partly  by  beverages,  partly  by  solid  food  containing  a 
percentage  of  water. 

For  all  tissues,  for  all  processes  of  diffusion,  for  the 
proper  acting  of  the  gastric  juices  a  certain  amount  of 
salts  must  be  an  ingredient  of  our  food — -phosphates,  sul- 
phates, chlorides,  and  carbonates. 

Food  consisting  only  of  albumen,  fat,  carbohydrates, 
water,  and  salts,  would,  however,  be  taken  only  with  dis- 
like. To  overcome  this  there  must  be  added  a  savoring. 
Under  this  designation  we  understand  partly  the  relish- 
able  substances  contained  in  the  food  or  subsequently 
added  to  it  (the  relishable  state  of  roasted  meat,  the 
flavor  of  fruit,  of  wine,  of  lemon,  seasoning  spices,  such  as 
pepper,  mustard,  etc.),  partly  articles  indulged  in  for 
their  stimulating  effect  upon  the  nervous  system,  like 
coffee,  tea,  alcohol,  tobacco. 


30  PASTORAL   MEDICINE. 

The  importance  of  relishable  food  is  found  principally 
in  the  fact  that  it  creates  a  desire  to  take  nourishment. 
Human  beings  are  most  sensitive  in  this  respect.  Not 
only  does  the  appearance  of  the  food  sometimes  cause 
them  to  detest  it,  but  their  appetite  is  very  easily  dulled 
by  a  prolonged  diet  of  the  same  food,  prepared  in  the 
same  manner.  Man  requires  a  variety  in  his  food.  This 
necessity  has  been  discovered  especially  in  educational 
and  other  institutions.  Nothing  is  more  abhorred,  for  in- 
stance, by  the  inmates  of  prisons  than  the  monotonous  bill 
of  fare  there  prevailing.  To  the  clergyman  who  may  be 
called  to  act  as  a  member  of  the  Board  of  Administration 
of  some  hospital,  orphan  asylum  or  similar  institution,  the 
knowledge  of  this  fact  is  of  interest. 

Among  inmates  of  orphan  or  similar  asylums  a  disease 
is  frequently  met  with  in  which  food  plays  an  important 
part,  namely,  scrofula,  a  sister  sickness  of  tuberculosis. 
In  children  of  the  tenderest  age  it  is  the  cereal  food  which 
causes  this  disease,  either  by  disturbing  the  process  of 
transformation  of  matter  in  the  body,  or  by  creating  con- 
ditions favorable  to  the  disease,  if  an  inclination  to  the 
same  has  been  inherited.  In  larger  children  a  cereal  and 
potato  diet  favors  a  further  development  of  scrofula. 

In  the  diet  of  orphanages  milk  and  meat  should,  there- 
fore, play  an  important  part. 

In  the  diet  of  the  sick  we  must  make  a  distinction  be- 
tween the  nourishment  of  patients  in  feverish  condition 
and  those  who  are  convalescent.  There  is  also  a  diet  for 
people  inclined  to  obesity,  etc. 

In  former  times  the  principle  prevailed  to  prescribe  diet- 
ing for  every  sick  person.  By  this  was  understood  the 
nourishing  of  the  patients  with  thin,  weak  soups.  The 
partaking  of  nourishing  foods  was  considered  harmful  for 
patients.  In  our  days,  we  know  that  the  fever  patient, 


NUTRITION   AND   FOOD.  31 

for  instance,  suffers  an  increased  and  accelerated  change 
of  matter  in  his  body.  Through  the  increased  secretion  of 
important  substances  during  the  fever,  the  weight  of  the 
body  decreases  rapidly.  The  nourishment  of  fever  pa- 
tients has  for  its  task  to  give  compensation  for  this  waste, 
or  to  restrain  it  as  much  as  possible. 

In  such  diseases  the  use  of  fine  flour,  rice,  and  maltose 
is  to  be  strongly  recommended.  By  employing  carbo- 
hydrates the  decomposition  of  albumen  will  be  greatly 
prevented.  As  the  fever  abates,  albumen  in  easily  di- 
gestive form,  such  as  peptone,  finely  minced  meat,  or  beef 
tea  may  be  given. 

As  mentioned  before,  a  healthy  person  needs  between 
four  and  five  pounds  of  water  daily.  The  fever  patient 
with  his  increased  temperature  needs  even  more,  and  it  is 
a  great  comfort  to  him.  After  the  crisis  of  the  sickness 
has  passed  the  convalescent  needs  more  albumen  for  the 
production  of  muscle.  As  the  digestive  powers  become 
stronger  more  carbohydrates  and  albumen  should  care- 
fully and  gradually  be  added  to  the  food,  and  it  may  be 
given  more  frequently.  Overloading  of  the  stomach 
should  be  avoided,  as  it  is  an  erroneous  idea  that  a  frail 
child  or  feeble  patient  can  speedily  be  brought  back  to 
normal  strength  by  the  consumption  of  concentrated  and 
rich  food. 

In  contrast  to  the  forms  of  diet  having  in  view  the  main- 
tenance or  recovering  of  normal  condition  of  the  human 
body,  there  is  the  reducing  diet  for  obese  persons.  The 
nutrition  of  our  body  does  not  intend  the  accumulation  of 
fat.  If  such  accumulation  occurs  in  individuals,  owing  to 
predisposition  or  a  faulty  mode  of  life,  it  may  easily  be- 
come the  cause  of  serious  maladies.  Excessive  depositions 
of  fat  hinder  the  activity  of  the  muscles,  particularly  of 
the  muscles  of  the  heart.  They  cause  shortness  of  breath, 


32  PASTORAL   MEDICINE. 

deterioration  of  the  blood,  and  finally  dropsical  secretions 
into  the  cells  and  cavities  of  the  body.  A  consumption  of 
fat  and  carbohydrates,  accompanied  by  sedentary  habits, 
are  most  favorable  for  obesity.  The  oldest  and  best  known 
cure  for  obesity  is  the  one  prescribed  by  the  English  phy- 
sician Hardy  for  a  patient  of  his,  named  Banting,  hence 
called  Banting  cure. 

Under  this  cure  there  are  omitted  from  the  food  all 
substances  of  fat  and  carbohydrates.  Only  nitrogenous 
food  is  allowed,  meat  and  little  bread;  beverages  only 
in  small  quantity.  Enforced  exercise  is  an  important 
part  of  the  cure.  This  cure  soon  causes  a  distressing  feel- 
ing of  hunger,  the  digestion  becomes  impaired,  the  body 
becomes  poor  in  albumen,  and  a  general  weakness  fol- 
lows. 

Attempts  to  cure  obesity  by  radical  means,  includ- 
ing diet,  are  always  dangerous.  A  prudent,  regular,  and 
frequent  exercise,  and  avoiding  of  luxurious  food  and 
drink  are  the  most  rational  and  safest  cure.  Like  many 
other  evils,  obesity  is  more  easily  prevented  than  cured. 

Fasting  and  Abstaining. 

In  sketching  the  physiologic-chemical  aspect  of  the 
nutrition  of  the  human  body  it  will  not  be  amiss  to  throw 
a  side  glance  from  a  hygienic  standpoint  upon  the  law  of 
the  Church  concerning  fasting  and  abstaining.  It  is  well 
known  that  the  interpretation  of  this  law  is  a  very  mild 
one,  and  one  which  takes  in  its  enforcement  considerable 
account  of  individual  conditions.  The  reproach  made 
against  the  Church  for  the  enforcement  of  this  law,  there- 
fore, arises  more  from  a  general  disinclination  to  obey  her 
laws  than  from  other  reasons.  It  is  apparent  that  the 
observing  of  the  law  concerning  the  nutrition  of  the  body 
must  vary  with  the  climate.  Every  ecclesiastical  ordinary 


FASTING  AND  ABSTAINING.  33 

in  charge  will,  therefore,  before  publishing  an  order  of 
fasting,  take  into  consideration  local  as  well  as  social  con- 
ditions among  the  people  of  his  diocese. 

From  fasting  are  excused  working  people  who,  in  the 
performing  of  their  daily  labor,  are  obliged  to  exacting 
bodily  exertion.  Exacting  exertion  is  not  only  that  accom- 
plished by  manual  labor,  but  also  that  which  requires  great 
mental  strain,  for  instance,  close  study.  To  this  class  should 
be  counted  especially  theological  students.  For  these  young 
men  there  is  great  danger  that  their  great  zeal  for  observ- 
ing the  laws  of  fasting,  while  engaged  in  arduous  studies, 
will  lay  a  seed  of  physical  infirmity,  and,  therefore,  the 
superior  of  the  institution  should  restrain  them  with  a 
loving  hand.  While  considering  the  status  of  the  clerical 
profession,  we  must  not  forget  to  mention  the  orders  and 
religious  societies  which  have  the  nursing  of  the  sick  for 
their  object.  The  nursing  of  the  sick  makes  such  heavy 
demands  upon  physical  strength  that  any  restriction  in  the 
matter  of  food  is  usually  out  of  the  question,  if  the  in- 
dividual is  to  perform  his  or  her  duties  satisfactorily  and 
without  injury  to  self.  Besides,  a  body  with  an  empty 
stomach  is  exposed  in  an  increased  degree  to  the  danger 
of  infection. 

The  abstaining  from  flesh  meat  is  of  less  importance  for 
nutrition.  It  can  be  accomplished  by  almost  everybody 
at  the  times  when  the  Church  demands  it.  Only  the  sick 
and  convalescent,  especially  those  suffering  from  stomach 
complaints  and  to  whom  fish  and  farinaceous  food  cause 
indisposition,  may  be  entitled  to  dispensation. 

From  a  hygienic  standpoint  the  rule  in  the  interpreta- 
tion of  the  law  of  the  Church  should  be :  Liberality  with 
regard  to  the  law  of  fasting  and  strict  observance  of  the 
law  of  abstaining. 


34  PASTORAL   MEDICINE, 


Food. 

After  this  diversion  we  now  turn  to  the  different  kinds 
of  food,  and  we  will  endeavor  to  state  briefly  the  demands 
which  hygiene  makes  upon  them. 

The  first  demand  is  that  food  must  not  become  a  source 
of  disease;  furthermore,  it  must  be  put  upon  the  market 
unadulterated. 

We  will  first  take  under  consideration  food  obtained 
from  the  animal  kingdom,  i.  e.,  meat,  milk,  and  eggs. 
Meat,  for  our  food,  we  obtain  from  domestic  animals,  also 
from  wild  fowl,  game,  and  fish.  Cattle  furnish  the  prin- 
cipal supply,  the  foremost  in  value  being  the  meat  of  beef. 

Particularly  tender,  free  from  fat  and  easily  digestible 
is  the  flesh  of  young  fowl,  wild  or  domestic.  To  soften 
the  tough  meat  of  wild  fowl  it  should  be  soaked  for  some 
time  in  sour  milk. 

Veal  contains  more  water  and  lime  than  beef.  Taste  and 
nutritious  value  depend  upon  the  age  of  the  animal  and 
of  the  quality  of  its  feed.  Pork  contains  considerable  fat 
and  is  harder  to  digest,  yet  it  is  a  popular  and  favorite 
food  among  all  nations.  Horseflesh  has  a  sickening,  sweet- 
ish taste. 

The  meat  of  fish  is  mostly  free  from  fat  and,  therefore, 
easily  digestible ;  exceptions  are  the  eel  and  salmon,  which 
have  large  deposits  of  fat,  and  for  that  reason  their  meat 
is  harder  to  digest. 

It  is  well  known  that  the  quality  of  the  flesh  of  cattle 
varies  in  accordance  with  the  food  they  receive. 

The  consumption  of  meat  is,  under  certain  conditions, 
accompanied  by  considerable  danger  to  human  health,  for 
instance,  owing  to  animal  parasites,  as  trichinae  and  tape- 
worms. 


FOOD.  35 

Trichinae  are  small,  slender  worms  which  in  the  larval 
state  are  parasitic  in  the  muscles  of  the  hog.  If  intro- 
duced, by  the  eating  of  raw  or  insufficiently  cooked  pork, 
in  the  human  stomach  the  trichinae  are  liberated  and  rap- 
idly become  adult,  producing  large  numbers  of  young, 
which  find  their  way  into  the  muscles  and  bowels,  produc- 
ing the  disease  called  trichinosis.  Another  parasite  may  be 
acquired  by  the  consumption  of  meat  from  a  hog  affected 
with  pork  measles.  Such  meat  is  filled  with  larvae  of 
tapeworms,  which  will  thus  enter  the  human  body  and 
grow  there.  By  eating  raw  beef  another  tapeworm  may 
be  acquired,  larger  and  stronger  than  the  one  found  in 
pork.  Pork  strongly  affected  by  pork  measles  is  of  offen- 
sive appearance  and  unfit  for  use. 

But  it  is  not  only  from  the  parasites  of  the  flesh  of 
warm-blooded  animals  that  we  may  acquire  tapeworms; 
there  is  the  same  danger  in  the  consumption  of  some 
kinds  of  fish,  as,  for  instance,  salmon,  pickerel,  etc. 

Besides  these  parasites,  certain  diseases  of  cattle  may 
be  transferred  into  the  human  system  by  eating  contam- 
inated flesh.  Such  diseases  are  murrain,  rabies,  festering 
sores,  and  tuberculosis.  Particularly  the  latter,  occurring 
in  cattle  and  hogs,  is  deserving  of  the  closest  attention  in 
hygiene.  This  disease  is  not  at  all  scarce  in  cattle.  An 
investigation,  conducted  in  the  state  of  Saxony,  proved 
that  over  eleven  per  cent,  of  the  cattle  killed  there  in  pub- 
lic slaughtering  houses  were  infected  with  tuberculosis. 

The  flesh  and  milk  of  tuberculous  animals  are  doubtless 
more  or  less  dangerous.  The  products  from  the  milk  of 
such  animals,  such  as  cream,  butter,  and  cheese,  retain  the 
contagious  qualities. 

Slaughtered  meat  may  be  considered  as  dangerous  to 
health  if  instead  of  a  fresh  bright  red  color  it  has  a 
brownish,  greenish,  or  very  pale  red  color,  or  if,  when 


36  PASTORAL   MEDICINE. 

squeezed,  there  flows  from  it  freely  a  discolored  juice; 
if  the  fat,  instead  of  hard  and  solid,  is  flabby  and  jelly- 
like  ;  when  the  marrow  of  the  hindquarter  is  not  firm  and 
of  roseate  hue,  but  soft  and  of  a  brownish  color.  Spoiled 
and  tainted  meat,  moreover,  emits  an  offensive  smell. 
Sellers  of  meat,  however,  know  how  to  remove  this 
smell.  It  may,  nevertheless,  be  detected  by  thrusting  a 
knife,  which  has  previously  been  dipped  in  hot  water,  into 
the  meat.  The  knife  when  removed  will  retain  and  be- 
tray any  bad  smell  that  there  may  be  in  the  meat.  The 
quality  of  smoked  ham  may  be  proved  in  a  similar  man- 
ner by  driving  a  clean  nail  into  the  meat  right  down  to 
the  bone.  If,  withdrawn  quickly,  the  nail  has  a  foul 
smell,  the  quality  of  the  meat  is  suspicious. 

To  avoid  the  injury  to  which  human  health  is  exposed 
by  the  consumption  of  meat,  special  laws  and  regulations 
for  the  slaughtering  of  animals  have  been  enacted  since 
the  earliest  times.  Moses  and  the  writers  of  the  Talmud 
allowed  their  people  to  slaughter  only  certain  species  of 
animals  for  the  purpose  of  consumption,  declaring  all 
others  unclean.  The  slaughter  of  animals  was,  moreover, 
subject  to  certain  regulations. 

Freshly  slaughtered  meat  is  not  suitable  for  immediate 
consumption.  It  is  tough  and  has  a  sickly,  sweetish  taste. 
After  being  properly  kept  for  two  or  three  days  it  de- 
velops an  acid  which  renders  it  tender  and  fit  for  use. 

Fresh  meat  is  usually  kept  in  ice  houses.  This  mode  of 
keeping  meat  is  not  as  beneficial  as  it  would  first  appear. 
The  surface  of  the  meat  under  ice  treatment  becomes 
thoroughly  moistened  and  softened  and  offers  in  this  con- 
dition a  favorable  place  for  the  settlement  of  bacteria  of 
decomposition.  Meat  kept  in  this  manner,  therefore, 
spoils  very  quickly  after  it  is  removed  from  the  ice  box 
and  if  not  immediately  used. 


FOOD.  37 

Much  more  rational  is  the  hanging  of  meat  in  cold, 
moving  air.  Under  this  treatment  a  dry  layer  is  formed 
on  the  surface  and  the  bacteria  of  decomposition  do  not 
find  a  favorable  place  for  settling.  Experts  in  hygiene, 
therefore,  recommend  for  the  magazines  of  abattoirs  the 
use  of  iced  but  dry  air,  kept  in  circulation  by  suitable 
means. 

Care  must  also  be  taken  to  protect  meat  from  flies, 
which  cause  maggots  to  develop  in  the  meat,  and  may  con- 
vey other  infection  dangerous  to  human  health. 

Since,  under  certain  circumstances,  a  constant  supply  of 
fresh  meat  is  difficult  or  impossible,  methods  had  to  be 
found  to  make  it  retain  its  good  quality  for  a  length  of 
time,  i.  e.,  to  preserve  it.  The  principal  requirements  of 
the  proper  preserving  of  meat  are  that  no  injurious  sub- 
stances are  brought  into  contact  with  it  and  that  the  nour- 
ishing properties  and  the  flavor  are  not  impaired.  The 
methods  most  universally  in  use  are  salting,  smoking,  and 
canning.  By  impregnating  meat  with  a  strong  solution  of 
salt  (8-12%)  the  bacteria  of  decomposition  are  prevented 
from  settling  and  spreading.  If  meat  thus  salted  is  then 
dried  in  well  ventilated  rooms,  and  afterward  smoked 
over  a  smoldering  wood-fire,  good  results  will  be  ob- 
tained and  there  will  be  no  danger  of  infection  by  para- 
sites (smoked  ham,  sausage).  In  contrast  with  this 
time-honored  method  of  thoroughly  smoking  the  meat, 
the  modern  method  of  rapid  smoking  is  to  be  deprecated. 
By  this  method  the  meat  is  dipped  into  a  compound  of 
water,  wood-vinegar,  and  juniper  oil  and  afterward  dried. 
This  process  does  not  kill  certain  parasites  and  bacteria, 
'  and  the  flavor  of  the  meat  is  impaired. 

The  food  next  in  importance  to  meat  obtained  from  the 
animal  kingdom  is  milk. 

Milk  is  principally  obtained  from  cows  and  goats.    Goat 


38  PASTORAL   MEDICINE. 

milk  as  a  popular  food  is  of  great  importance.  It  con- 
tains more  fatty  substances  than  cows'  milk,  but  has  less 
sugar.  It  should  receive  particular  consideration.  Its 
availability  is  increased  by  the  fact  that  goats  are  easily 
and  inexpensively  obtained,  their  maintenance  costs  next 
to  nothing,  and  they  are  hardly  ever  affected  with  disease. 

The  greatest  supplier  of  milk  is  the  cow,  and  the  feed- 
ing and  keeping  of  this  animal  are  of  great  influence 
upon  the  quality  of  its  milk.  Insufficient  feeding  of  milk- 
ing cows,  either  with  dry  or  green  fodder,  has  as  a  con- 
sequence the  production  of  watery  milk,  devoid  of  fatty 
substances.  The  kind  of  fodder  itself  is  of  equal  im- 
portance. Poisonous  herbs,  such  as  meadow  saffron  or 
ranunculus,  render  the  milk  of  animals,  devouring  them 
while  grazing,  detrimental  to  health,  particularly  to  infants. 
Milch  cows  should  be  kept  scrupulously  clean,  in  well 
ventilated  stables.  Their  bodies  should  be  carefully  cleaned 
every  day,  because  experience  teaches  that  a  well  groomed 
animal  furnishes  a  superior  quality  of  milk.  Furthermore, 
proper  care  should  be  taken  in  the  handling  of  the  milk 
until  it  is  put  to  use.  Soon  after  it  has  been  drawn  from 
the  udder  it  should  be  poured  through  a  fine  sieve  to 
cleanse  it  of  impurities,  and  should  then  be  kept  in  cool 
rooms.  Milk  should  not  be  kept  in  vessels  of  copper,  brass 
or  tin,  nor  in  jars  covered  with  cheap  glazing  or  made  of 
cast  iron  and  lead  enamel^  as  the  milk  easily  absorbs  in- 
jurious matters. 

The  place  where  milk  is  stored  should  not  be  in  close 
vicinity  to  sleeping  or  sick  rooms,  and  persons  who  are 
nursing  patients  afflicted  with  contagious  diseases  should 
not  be  allowed  to  handle  milk.  Milk  is  preeminently  fitted 
to  be  a  vehicle  of  the  germs  of  contagious  diseases. 
Cholera,  typhoid,  and  scarlet  fever  have  often  been  spread 
by  infected  milk.  A  mother  who  has  just  been  attending 


FOOD.  39 

her  child  sick  with  scarlet  fever,  may  convey  germs  of  the 
disease  to  the  milk  handled  by  her  and  given  to  her  other 
healthy  children,  who  will  imbibe  these  disease  germs  and 
very  likely  get  the  disease.  Milk  may  also  in  other  ways 
be  the  cause  of  the  spread  of  contagious  diseases.  If  the 
milk  cans  are  washed  with  impure  water  containing 
disease  germs  they  will  adhere  to  the  sides  of  the  vessels, 
get  into  the  milk  and  through  it  reach  the  consumer.  The 
spreading  of  cholera  and  typhoid  fever  has  been  traced  to 
this  source. 

Unscrupulous  milk  dealers  injure  the  consumer's  health 
by  selling  adulterated  milk.  The  ordinary  way  of  adulter- 
ating milk  is  by  the  adding  of  water.  The  defective 
quality  of  such  milk  is  detected  by  the  milk  scale  or  by 
chemical  analysis. 

The  most  important  ingredient  of  milk,  cream,  appears 
on  the  surface  if  the  milk  is  allowed  to  stand  without  dis- 
turbance for  about  twenty-four  hours.  By  the  buttering 
process  butter  is  obtained  from  the  cream,  the  quality  of 
which  corresponds  directly  with  the  quality  of  the  milk 
from  which  it  is  obtained,  and  with  the  care  employed  in 
its  handling.  After  removing  the  butter  there  remains  in 
the  churn  the  buttermilk,  which,  in  its  fresh  state,  is  a 
wholesome,  cooling  drink,  containing  considerable  nour- 
ishment. Skimmed  milk,  though  not  as  nutritious  as  un- 
skimmed milk,  is  of  no  little  value  as  a  food  and  for 
household  purposes. 

Cheese,  also  a  dairy  product,  is  an  excellent  and  rich 
food,  containing  much  nitrogen,  but  not  always  easy 
to  digest. 

To  the  articles  of  animal  food  belong  also  the  eggs. 
The  component  parts  of  an  egg  are  about  two-thirds  wa- 
ter and  for  the  rest  pure  albumen  and  fat  in  nearly  equal 
portions.  The  fat  is  in  the  yolk,  and  gives  it  its  yellow 


40  PASTORAL   MEDICINE. 

color.  Eggs  contain  none  of  the  sugar  principles,  and 
should  be  eaten  with  bread  or  vegetables  that  contain 
them.  Hard-boiled  or  fried  eggs  require  longer  time  to 
digest  than  soft-boiled.  The  latter  are,  therefore,  more 
wholesome. 

We  will  now  turn  to  the  food  obtained  from  the  vege- 
table kingdom.  In  the  first  place,  we  must  place  under 
this  head  the  food  which  is  the  most  indispensable  and 
most  universally  used  food  of  all,  i.  e.,  bread.  Bread  is 
obtained  from  the  flour  of  cereals  mixed  with  water,  with 
an  addition  of  leaven  or  yeast,  into  a  dough.  Fermenta- 
tion then  takes  place  in  the  dough,  changing  part  of  the 
starch  contained  in  the  flour  into  sugar,  alcohol,  and  car- 
bonic acid.  This  latter  causes  the  rising  of  the  dough 
and  gives  to  the  bread  its  spongy  condition,  which  alone 
makes  it  digestible.  The  kneaded  and  molded  dough  is 
then  baked  in  the  oven. 

Good  flour  should  be  yellowish-white,  and  not  of  a  red 
or  bluish  tint.  It  should  have  a  dry,  smooth,  yet  solid 
touch,  and  there  should  be  no  lumps  in  it.  If  a  quantity  is 
pressed  together  in  the  hand,  it  should  give  a  crunching 
sound,  and  when  released  should  readily  fall  apart.  The 
flavor  of  the  flour  must  not  be  moldy.  Its  taste  should  be 
sweet,  not  sour  or  offensively  bitter.  A  grating  sound  of 
flour  when  taken  between  the  teeth  shows  that  it  contains 
sand. 

Flour  becomes  detrimental  to  health  if  the  cereal  from 
which  it  is  obtained  is  tainted  by  certain  fungous  diseases. 
Rye  bread  often  contains  spawn  of  ergot,  kernels  of  dark 
color  a  little  larger  than  rye  grain.  Ergot  is  a  fungus 
which  settles  as  a  parasite  on  the  young  rye  grain,  par- 
ticularly in  very  wet  seasons. 

If  the  flour  contains  as  much  as  1-2%  of  ergot  its  use 
will  cause  a  sickness  called  raphany.  This  sickness 


FOOD.  41 

caused  in  former  times  great  loss  of  life,  especially  toward 
the  end  of  the  sixteenth  and  at  the  beginning  of  the 
seventeenth  century.  Even  in  our  own  time  small  epi- 
demics due  to  ergot  occur  occasionally  in  damp  regions, 
for  instance,  in  the  department  of  Sologne,  in  France. 

If  rye  flour  thus  contaminated  is  mixed  with  pure  wa- 
ter in  a  dish  of  white  china,  it  will  show  a  peculiar  reddish- 
brown  color,  while  pure  rye  flour  will,  under  the  same 
treatment,  remain  purely  white.  The  impurity  can  also  be 
detected  by  chemical  analysis. 

Another  health-disturber,  also  of  parasitic  origin,  is 
sometimes  found  in  the  flour  of  maize,  or  Indian  corn. 
It  causes  a  disease  named  pellagra  and  occurs  frequently 
in  northern  Italy. 

The  fruit  of  leguminous  plants,  such  as  peas,  beans,  and 
lentils,  are  particularly  rich  in  albumen.  Potatoes  con- 
tain principally  starch-flour  and  water,  with  very  little 
albumen.  They  are  a  favorite  and  indispensable  food  of 
the  people,  meeting  adequately  the  demands  of  the  body 
for  hydrates  of  carbon.  Some  meat  should  neces- 
sarily be  taken  with  them,  because  if  albumen  is  not  sup- 
plied from  some  source,  a  potato-diet  will  soon  cause  dis- 
turbed digestion. 

Green  vegetables  are  very  valuable,  owing  to  their 
palatableness  and  on  account  of  the  salts  which  they  sup- 
ply to  the  body.  Their  actual  nutritious  value  is  small, 
but  they  contribute  to  the  easy  digestion  of  other  food, 
and  they  are  a  great  help  in  the  maintenance  of  good 
health  in  the  organic  body.  Fresh  fruit  is  wholesome  on 
account  of  its  agreeable  taste  and  of  the  change  in  the  diet 
which  it  offers.  It  is  also  of  some  nutritious  value,  which 
is  determined  by  its  contents  of  sugar.  The  agreeable 
taste  is  caused  by  fruit  acids. 

As  explained  before,  civilized  man  craves  for  his  nutri- 


42  PASTORAL   MEDICINE. 

tion  besides  the  actual  means  of  sustenance  also  stimu- 
lants and  articles  to  gratify  the  taste. 

The  first  consideration  among  stimulants  must  be 
given  to  alcoholic  beverages.  The  active  principle  of 
these  beverages  is  alcohol,  an  odorless  liquid,  which 
mixes  freely  with  water  under  all  conditions.  Its  effect 
upon  the  human  organism,  when  taken  moderately, 
is  stimulating — the  action  of  the  heart  is  increased  and 
the  nervous  system  becomes  animated.  Taken  in  large 
quantities  it  causes  stupor  and  prostration,  and  even  sud- 
den death.  Alcohol,  besides,  works  upon  the  gastric  juices 
of  the  stomach  and  appeases  the  feeling  of  hunger.  An 
undesirable  ingredient  accompanying  many  alcoholic 
liquors  is  fusel  oil.  Fusel  oil  has  a  penetrating,  offensive 
odor.  Its  presence  in  liquor  can  be  discovered  by  rubbing 
some  of  the  liquor  between  the  two  hands,  when  the  odor 
will  be  noticeable.  The  fusel  oil  of  potatoes  is  more  dan- 
gerous to  health  than  that  of  rye.  Fusel  oil  is  the  principal 
agent  to  cause  a  detrimental  effect  upon  health  by  a  mis- 
use of  alcoholic  drinks,  although  excess  in  the  use  of  alco- 
holic drink  will,  also  for  other  reasons,  injure  health. 
The  misuse  of  alcohol,  and  inebriation,  will  be  given 
further  attention  in  another  chapter. 

Some  of  the  best  known  alcoholic  drinks  are : 
(i)  Liquors.  They  are  produced  from  the  starch  of  rye, 
barley,  potatoes,  etc.,  by  transforming  it  by  mashing  into 
fermentable  sugar.  Through  fermentation  there  are  de- 
veloped alcohol,  carbonic  acid,  glycerine,  and  small  quanti- 
ties of  other  organic  acids.  By  a  distilling  of  this  fer- 
mented matter  the  alcohol  is  secured,  which,  through  the 
mixing  with  water,  is  made  into  the  drinkable  liquor.  Of 
alcoholic  drinks  it  is  principally  liquor  which  contains 
fusel  oil.  To  prevent  danger  to  health,  this  ingredient 
must  not  amount  to  more  than  1-10%.  Rum  is  manufac- 


STIMULANTS.  43 

tured  from  sugar  sirups,  brandy  by  distilling  of  grape 
wines,  arrack  from  malted  and  fermented  rice.  It 
may  be  mentioned  that  these  three  kinds  of  liquors  are 
generally  sold  in  an  adulterated  state,  and  are  but  seldom 
genuine. 

(2)  Beers  and  ales  are  obtained  by  a  yeast  fermentation, 
without  distillation,  of  a  mixture  of  malt,  hops,  and  water. 
They  contain  relatively   little   alcohol.     A   considerable 
amount  of  hop  resin  contained  in  new  beer  may  cause  a 
violent  and  painful  irritation  of  the  bladder.     Good  beer 
is  wholesome  and  nutritious,  owing  to  its  contents  of  hy- 
drates of  carbon  and  salts.    Taken  in  small  quantities  it 
may  prove  of  benefit  to  convalescents  and  individuals  of 
poor  condition  of  the  blood,  owing  to  its  stimulating  effect 
upon  the  appetite.     It  retards  digestion  if  taken  in  large 
quantities.     Persons  inclined  to  obesity  should  take  beer 
very  sparingly  or  better  avoid  it  altogether.    In  moderate 
quantities  it  is  of  benefit  also  to  nervous  persons.     It 
calms  their  nerves  and  induces  sleep. 

(3)  Wine.    Ripe  grapes  are  crushed,  and  the  juice  so 
obtained  is  kept  for  some  days,  with  the  skin  and  seed- 
kernels  left  in  the  same,  so  as  to  thoroughly  absorb  the 
substances  which  give  wine  its  peculiar  flavor.     White 
wine  is  then  pressed  out  of  this  mass,  while  red  wine  is 
not  pressed  until  after  fermentation,  as  only  the  acids  of 
fermentation  will  extract  color  from  the  grapes.     Good 
wine  is  of  great  benefit  if  taken  moderately.    To  aged  peo- 
ple, in  whom  the  functional  energy  is  weakened,  wine  is 
of  great  consequence. 

Of  course,  an  excessive  consumption  of  wine  can  not 
help  but  be  injurious.  Chronic  alcoholism  is  found  with 
the  habitual  drinker  of  wine  as  well  as  with  the  drinker 
of  strong  liquor.  Gout  is  generally  the  result  of  the  con- 
tinued drinking  of  heavy  wines. 


44  PASTORAL   MEDICINE. 

Children  should  not  take  alcoholic  drinks  of  any  kind, 
unless  prescribed  in  case  of  sickness. 

Other  stimulating  beverages,  gratifying  to  the  taste,  are 
coffee,  tea,  and  chocolate.  The  drink  we  call  coffee  is  an 
infusion  of  the  seeds  of  the  coffee  tree.  Before  being  put 
to  use,  the  coffee  beans  are  roasted.  By  this  process  the 
wooden  fiber  is  carbonated  and  the  aroma  is  developed. 
The  action  of  coffee  upon  the  nervous  system  is  stimulat- 
ing— it  produces  energetic  action  of  the  heart  and  kindles 
the  mental  and  physical  powers.  Coffee  is  adulterated  in 
many  ways.  The  meal  of  wheat  and  Indian  corn  are  used 
to  produce  artificial  coffee  beans,  which  are  so  like  the 
genuine  bean  that  only  a  microscopic  or  chemical  analysis 
can  tell  the  difference. 

A  simpler  method,  however,  of  detecting  adulteration  is 
the  following:  If  put  in  ether,  the  artificial  bean  will  at 
once  sink  to  the  bottom,  while  the  genuine  bean,  on  ac- 
count of  its  fatty  substance,  will  float  for  some  time. 

Roasted  and  ground  coffee  offers  a  great  opportunity 
for  adulteration.  Ground  coffee  especially  is  largely 
adulterated  with  shavings  of  iron,  with  sand,  clay,  etc. 

Tea  is  the  infusion  of  the  leaves  of  the  tea  shrub  after 
they  have  been  prepared  by  heating,  roasting,  or  slight 
fermentation.  Tea  is  adulterated  by  the  admixture  of 
leaves  of  various  kinds. 

From  the  fruit  of  the  cocoa  tree  there  is  obtained  cocoa, 
which,  with  an  admixture  of  sugar  and  spices,  is  made 
into  chocolate. 

Cocoa  differs  from  tea  and  coffee  in  that  respect  that, 
if  properly  prepared,  it  furnishes  a  very  nourishing  bever- 
age. The  nourishing  ingredients  of  cocoa  are  dissolved 
if  the  powdered  cocoa,  mixed  with  eight  parts  of  milk,  is 
boiled  for  ten  minutes  under  constant  stirring. 

Ingredients  used  in  the  preparation  of  food  either  to 


STIMULANTS.  45 

give  taste  or  to  aid  digestion  are  called  spices  or  condi- 
ments. Their  importance  is  found  in  their  effect  upon 
the  digestive  channels  in  exciting  an  increased  secretion 
of  the  gastric  juices.  Such  spices  are  cloves,  black  pepper, 
red  pepper,  mustard,  horseradish. 

The  most  indispensable  spice  for  foods  is  table  salt.  It 
plays  a  very  important  part  in  the  household  of  the  body. 
The  great  natural  craving  for  it  sufficiently  indicates  its 
importance. 

We  must  not  conclude  this  chapter  without  mentioning 
the  use  of  tobacco,  which  first  was  found  in  use  among 
the  natives  of  America.  It  was  from  there  taken  to 
Europe.  Since  that  time  the  use  of  tobacco  has  been  con- 
stantly growing,  although  ecclesiastical  as  well  as  worldly 
authorities  have  at  various  times  endeavored  to  suppress 
or  at  least  restrict  the  use  of  it.  At  the  present  time  the 
world's  consumption  of  tobacco  amounts  to  from  six  to 
seven  hundred  million  pounds. 

The  most  prominent  ingredient  of  the  tobacco  plant  is 
nicotine,  a  narcotic  poison.  Nicotine  is  a  powerful  nerve 
stimulant,  which,  if  used  in  excess,  will  cause  palsy  or 
paralysis.  Tobacco  is  used  in  three  different  ways. 

The  use  least  detrimental  to  health  is  to  snuff  it.  Ac- 
cording to  a  medical  authority  500  grains  of  this  form  of 
tobacco  contain  only  0.062%  of  nicotine.  The  snuffing 
of  tobacco  is,  therefore,  not  so  detrimental  to  health  as 
the  use  of  it  in  other  forms,  although  in  the  form  of  snuff 
fraudulent  admixtures  to  it  would  be  more  difficult  to  de- 
tect. When  packed  in  tinfoil,  it  has  often  been  the  cause 
of  lead  poisoning. 

The  chewing  of  tobacco  is  largely  in  favor  with  persons 
who  have  outdoor  employment,  such  as  soldiers,  sailors, 
men  employed  in  the  building  trades,  etc. 

The  sanitary  influence  of  chewing  tobacco  has,  like  the 


46  PASTORAL   MEDICINE. 

use  of  any  kind  of  stimulant,  been  judged  in  various  ways. 
Anybody  who  has  had  occasion  to  examine  a  large  num- 
ber of  tobacco  chewing  men  will  have  to  acknowledge  that, 
as  a  general  rule,  they  are  healthy  individuals,  possessed 
especially  of  healthy,  strong  teeth.  At  any  rate,  the  use 
of  tobacco  in  this  form  does  not  seem  to  have  detrimental 
effects. 

The  smoking  of  tobacco  is  the  most  common  form  of 
using  it.  The  smoking  of  cigars  is  more  liable  to  be  detri- 
mental to  health  than  the  smoking  of  pipes,  because  in  the 
latter  the  smoke  has  to  pass  through  a  certain  distance 
before  it  reaches  the  mouth,  thus  losing  some  of  its 
irritating  qualities. 

The  effects  of  the  smoking  of  tobacco  upon  the  human 
body  are  local  as  well  as  general. 

If  done  to  excess,  it  will  cause  a  chronic  catarrh  of  the 
membrane  of  the  throat  and  secretion  of  a  mucous  phlegm, 
causing  irritation;  the  tongue  becomes  coated  and 
the  sense  of  taste  dulled.  The  eyes  become  inflamed  by 
the  smoke.  The  irritation  of  the  delicate  skin  of  the  lips, 
caused  by  the  continual  carrying  in  the  mouth  of  a  short 
pipe,  should  also  be  considered.  Cancer  of  the  lips  is 
sometimes  the  consequence. 

It  is  stated  by  medical  authority  that  a  moderate  use 
of  tobacco  increases  the  activity  of  the  brain  and  combats 
the  inclination  for  sleep;  it  has  a  soothing,  but  not  an 
exhilarating,  influence.  It  always  causes  a  slight  weaken- 
ing of  the  muscles.  The  secretion  of  saliva  is  increased  by 
smoking  tobacco,  which  thereby  becomes  an  aid  to  diges- 
tion; it  also  stimulates  the  action  of  the  bowels  and  the 
secretion  of  urine. 

Smoking  is  to  be  avoided  in  all  forms  of  chronic  catarrh 
of  the  various  membranes,  even  in  catarrh  of  the  bladder. 
In  suppuration  of  the  ear  it  is  particularly  harmful.  It 


DWELLING  AND  CLOTHING.  47 

should  also  be  avoided  in  cases  of  sleeplessness  produced 
by  mental  exertion,  in  weakness  of  the  heart,  and  neuralgic 
afflictions. 

Any  one  of  the  three  ways  of  consuming  tobacco 
becomes  detrimental  to  health  if  used  to  excess.  Proper 
consideration  of  fellow  beings,  moreover,  should  make 
us  careful  not  to  offend  decency  by  tobacco  use.  Chew- 
ing of  tobacco  especially  is  distasteful  and  insufferable 
among  people  of  refinement. 

IV. — DWELLING  AND  CLOTHING 

Our  climate,  our  morals,  our  habits  of  living,  our  oc- 
cupations, and  incidents  of  our  daily  life  cause  us  to 
spend  only  a  comparatively  small  part  of  our  time  in 
the  open  air.  Most  human  beings  spend  the  greater  part 
of  their  time  in  closed  rooms,  either  at  home,  or  accord- 
ing to  their  calling,  in  schools,  churches,  hospitals,  manu- 
facturing plants,  or  offices. 

It  is,  therefore,  apparent  that  the  dwelling  must  have 
an  important  influence  upon  the  condition  of  human 
health,  because  detrimental  influences  in  this  connection 
are  liable  to  be  of  lasting  effect.  From  a  hygienic  point 
of  view  we  are  interested  in  dwelling  in  three  different 
ways :  I.  The  location ;  2.  The  soil  upon  which  the  dwell- 
ing is  erected ;  3.  The  material  used  in  its  construction. 

The  location  is  the  healthier  the  more  free  access  at- 
mospheric air  and  sunlight  have  to  all  parts  of  the  dwell- 
ing. If  houses  are  built  too  closely  together,  if  the  court- 
yards or  airshafts  are  reduced  to  the  smallest  space,  the 
air  in  the  living  rooms  of  such  buildings  will  be  seriously 
impaired.  Consequently,  in  large  cities,  squares  and  open 
places,  particularly  if  planted  with"  trees  and  shrubbery, 
are  of  great  hygienic  value.  Dwellings  are  made  un- 


48  PASTORAL   MEDICINE. 

healthy  by  improperly  constructed  drains,  sewers,  or  by 
the  proximate  location  of  latrines  and  dunghills. 

This  topic  will  be  treated  more  fully  in  another  chapter 
of  this  work. 

Of  great  influence  upon  health  are  the  surroundings  of 
dwellings  in  industrial  centres.  Through  injurious  gases, 
smoke  from  factory  chimneys,  continuous  loud  noises, 
manufacturing  districts  become  unsuitable  for  dwelling. 

The  soil  upon  which  a  house  is  erected  may  be  con- 
sidered healthy  if  it  is  dry  sand  or  rock,  and  if  it  does  not 
contain  decaying  matter  or  stagnant  water.  The  building 
materials  generally  used  are  wood  and  brick.  The  mortar 
used  in  stone  buildings  contains  a  large  part  of  water,  so 
that,  in  the  just  finished  building,  there  is  contained  a  con- 
siderable quantity  of  water.  In  the  foundation  and  walls 
of  a  newly  erected  ordinary  brick  dwelling  there  are  con- 
tained many  thousand  quarts  of  water,  which  will  evap- 
orate. From  a  sanitary  point  of  view  it  is,  therefore,  ad- 
visable that  newly  erected  brick  buildings  should  not  be 
occupied  until  thoroughly  dried. 

Damp  walls,  such  as  in  new  buildings,  are  of  a  twofold 
consequence  in  regard  to  health.  In  the  first  instance, 
there  is  no  air  circulation,  because  air  can  not  penetrate 
the  pores  of  the  bricks  if  filled  with  water.  Furthermore, 
damp  walls  absorb  heat  in  a  much  greater  degree  than 
dry  walls.  Dwellers  in  houses  with  damp  walls  lose  a 
great  amount  of  bodily  heat  by  a  one-sided  radiation. 
Hence  the  uncomfortable,  chilly  feeling  that  one  experi- 
ences in  such  houses.  Further  consequences  of  a  pro- 
tracted stay  in  damp  rooms  are  rheumatism,  catarrh  of 
the  respiratory  organs,  kidney  trouble,  with  resulting 
dropsy.  Dampness  in  dwellings  may  also  be  due  to  the 
soil  upon  which  they  are  erected.  We  have  said  above 
that  the  ground  should  be  dry.  But  it  is  natural  that  this 


DWELLING.  49 

precaution  can  not  always  be  observed.  Therefore,  in 
order  to  prevent  the  ascending  of  dampness  through  the 
pores  of  the  bricks,  etc.,  it  is  advisable  to  cover  the  cellar 
floor  with  an  impenetrable  layer  of  cement. 

If  water  from  rains  or  floods  has  flowed  into  the  cellars 
or  basements  of  dwelling  houses,  it  should  be  pumped  out 
as  soon  as  possible,  because  such  water  is  sure  to  be  im- 
pure and  to  contain  a  great  deal  of  decaying  matter.  After 
the  water  has  been  removed  as  thoroughly  as  possible,  the 
remaining  moisture  should  be  disinfected  by  an  applica- 
tion of  a  mixture  of  carbolic  acid  and  water,  or  of  chlo- 
ride of  lime  and  water. 

Walls  are  treated  with  the  disinfectant  by  brushes  or 
mops ;  floors  are  cleaned  by  scrubbing  with  it. 

Public  institutions,  such  as  schools,  orphan  asylums, 
prisons,  and  hospitals,  should  be  most  carefully  attended 
to  in  the  described  manner  when  they  have  suffered  an 
inundation. 

We  will  now  take  under  consideration  those  parts  of 
a  dwelling  which  are  in  constant  use  as  living  rooms. 

Rooms  with  southern  exposure  are  preferable  to  those 
of  northern  exposure,  because  they  offer  a  free  access  to 
sunlight.  They  are  drier,  more  cheerful,  warmer  in  the 
cold  season,  and  benefited  by  the  southern  breezes  in  sum- 
mer time. 

Special  consideration  is  due  to  the  sanitary  conditions  of 
the  modern  flat  and  apartment  houses  in  large  cities.  Ac- 
cording to  the  late  Professor  Virchow  and  other  authori- 
ties, living-rooms  situated  on  the  fourth  or  fifth  story  are 
more  detrimental  to  the  health  of  their  inhabitants  than 
even  the  rooms  in  the  basement.  To  mention  only  one 
fact,  it  has  been  ascertained  that  the  greatest  percentage 
of  miscarriages  happen  among  women  living  on  the  upper 
floors. 


50  PASTORAL   MEDICINE. 

Care  should  be  taken,  whenever  possible,  to  have  sep- 
arate rooms  for  the  members  of  a  family,  because  the  air 
of  overcrowded  rooms  soon  becomes  vitiated  by  the  pro- 
cess of  respiration.  The  overcrowding  of  living  rooms 
does  not  only  take  place  in  large  cities,  but  also  happens 
frequently  in  the  country,  especially  in  winter  time. 

It  is  an  accepted  fact  that,  per  person  and  hour,  thir- 
teen cubic  feet  of  fresh  air  are  necessary.  The  air  of  the 
atmosphere  gains  access  through  the  cracks  of  windows 
and  doors,  and  also  through  the  pores  of  walls,  especially 
at  a  time  when  dwellings  are  heated.  Under  any  circum- 
stances this  access  of  air  has  largely  to  be  assisted  by  the 
opening  of  windows. 

It  has  been  found  lately  that  the  filling  between  ceiling 
and  flooring  is  frequently  injurious  to  health.  It  is  ap- 
parent that  the  slightest  defect  in  the  flooring  is  sufficient 
to  allow  the  space  under  floors  to  become,  in  the  course  of 
years,  an  accumulation  of  dirt  and  decaying  matter  which 
is  bound  to  breed  sickness.  This  is  essentially  the  case  in 
rooms  that  are  used  as  sick  rooms.  There  is,  therefore, 
also  great  danger  from  this  source  in  new  buildings  con- 
structed of  old  building  material.  By  microscopic  ex- 
amination it  has  been  found  that  old  material  used  for 
filling  in  between  floor  and  ceiling  contained  germs  of 
consumption,  typhus,  and  membranous  croup.  The  saf- 
est material  for  this  purpose  is  sand  or  ashes. 

To  make  our  living-rooms  comfortable  we  require  light- 
ing and  heating,  both  of  which  are  of  the  greatest  im- 
portance for  our  health. 

Great  progress  has  been  made  in  the  manner  of  light- 
ing. Starting  from  the  old  fashioned  candle  or  oil  lamp, 
there  has  come  into  use,  at  first  kerosene  oil,  then  gas,  and 
now  electric  light.  Let  us  now  inquire  into  the  sanitary 
conditions  of  the  various  modern  ways  of  illuminating. 


LIGHTING   AND    HEATING.  51 

Kerosene  is  found  in  the  bowels  of  the  earth,  deposited 
there  by  a  decomposition  of  vegetable  and  animal  matter. 

The  raw  kerosene^  or  petroleum,  is  made  available  for 
use  by  distillation.  Properly  distilled  kerosene  will  not 
develop  a  dangerous  amount  of  explosive  gases,  even  if 
exposed  to  a  high  degree  of  heat. 

One  of  the  most  widely  used  materials  for  lighting  pur- 
poses is  illuminating  gas,  usually  obtained  from  coal. 

Illuminating  gas  obtained  from  coal  requires  a  com- 
plicated process  of  purification  to  remove  obnoxious  and 
noncombustible  matter.  The  most  important  element  of 
illuminating  gas  as  regards  human  health  is  carbonic  acid 
gas,  because  it  is  well  known  as  a  deadly  poison  if  inhaled 
in  considerable  quantity.  By  the  process  of  burning  it  is 
changed  completely  into  carbonic  acid.  If  illuminating 
gas  saturates  the  air  to  the  extent  of  from  10-25%  the 
mixture  then  becomes  highly  explosive.  Accidents  due  to 
such  explosions  are  quite  frequent. 

In  our  times  electric  light  is  largely  taking  the  place  of 
illuminating  gas.  There  are  two  kinds  of  electric  light, 
the  arc  light  and  the  incandescent  light. 

The  first  is  produced  by  two  pieces  of  carbon,  which 
represent  the  positive  and  negative  pole  of  a  current  and 
consist  of  a  stream  of  glowing  particles  of  carbon. 

The  incandescent  light  is  formed  by  heating  a  thin  car- 
bon wire  in  a  vacuous  glass  bulb  until  it  glows. 

In  regard  to  health  we  have  to  consider  in  this  connec- 
tion principally  the  eyes,  which  are  greatly  affected  by 
artificial  light.  The  principal  requirement  is  that  the 
light  should  be  steady  and  not  flickering.  Lamp  shades 
are  of  great  importance  in  the  universally  accepted  mode 
of  lighting.  They  prevent  the  rays  of  the  light  from  fall- 
ing directly  into  the  eyes,  from  causing  a  strong  dazzling 
and  preventing  the  eyes  from  distinguishing  objects.  Such 


5*  PASTORAL   MEDICINE. 

shades  also  reflect  and  concentrate  the  light  upon  the 
working  table.  The  evenness  of  the  flame  is  of  im- 
portance, for  the  reason  that  a  flickering  or  wavering 
light  is  very  injurious  to  the  eyes. 

All  illuminating  materials,  excepting  the  incandescent 
light,  contaminate  the  air  of  living-rooms  by  the  process 
of  burning.  Besides,  they  create  a  considerable  amount 
of  heat.  A  burning  kerosene  lamp  emits  about  twelve 
times  the  amount  of  carbonic  acid  which  a  human  being 
does  by  respiration,  and  about  eight  times  more  of  heat 
and  vapor.  Kerosene  and  gas  are  about  equal  in  this 
respect. 

By  a  comparison  of  gas  and  electric  light  the  con- 
clusion is  reached  that  both  kinds  of  illumination  have, 
from  a  hygienic  standpoint,  their  advantages  and  disad- 
vantages. In  favor  of  electric  light  are  the  enhancing 
of  the  sense  of  color  and  the  keenness  of  vision,  the 
trifling  production  of  heat,  and  the  lack  of  corruption  of 
the  air;  against  it  are  its  vivid  dazzling  qualities  and  the 
danger  from  the  operation  of  a  strong  electric  current. 
The  disadvantages  adduced  against  gas  light  are  its  great 
production  of  heat  and  corruption  of  the  air,  as  well  as 
the  dangers  of  explosion,  and  of  poisoning  by  inhalation. 

The  advantages  of  the  electric  light,  from  a  sanitary 
point  of  view,  according  to  this,  are  almost  entirely  lack- 
ing in  gas. 

In  order  to  make  living  comfortable  in  dwelling  places 
in  our  latitudes  during  the  cold  part  of  the  year,  heating 
arrangements  are  indispensable.  The  first  object  of  every 
heating  apparatus  in  dwellings  is  to  keep  the  air  always 
at  a  temperature  agreeable  and  advantageous  to  the 
organism,  i.  e.,  of  from  64  to  70  degrees  Fahrenheit. 

The  quicker  the  heating  results,  the  easier  to  regu- 
late it,  the  less  contamination  of  the  air  is  caused  by  the 


HEATING.  53 

products  of  combustion,  so  much  the  more  perfect  are 
the  heating  arrangements,  if  they,  furthermore,  require 
little  time  for  attendance  and  are  as  economical  and  cheap 
as  possible.  We  distinguish  between  local  and  central 
heating  arrangements. 

In  local  heating  arrangement  the  heat-dispenser  is 
found  in  the  rooms  to  be  warmed.  To  this  class  belong 
the  stove  and  the  fireplace. 

The  construction  of  a  stove  is  such  that  the  fuel  must 
either  be  continually  put  on,  as  in  the  ordinary  stove,  or 
emptied  into  it  to  serve  for  a  longer  time,  as  in  the  self- 
feeding  stove. 

Ordinary  stoves  allow  of  a  quick  warming  of  rooms, 
but  require  continual  attention  lest  the  fire  should  as 
quickly  go  out.  The  handling  of  the  fuel  gives  rise  to 
a  troublesome  development  of  dust  and  thereby  to  the 
deterioration  of  the  air  in  the  room,  when  a  dust-pro- 
ducing substance  like  coal  is  used. 

The  common  material  of  which  stoves  are  made  is  iron. 
By  great  heat  the  thin  sides  of  the  stove  easily  become 
red  hot,  and  in  this  condition  permit  the  poisonous  car- 
bonic oxide  gas  to  pass  from  the  fire  chamber  to  the 
room.  To  guard  against  this  the  sides  of  the  stove  are  re- 
inforced by  the  inserting  of  a  fire  pot  in  the  fire  chamber, 
which,  however,  does  not  prevent  the  side  of  the  stove 
from  becoming  red  hot. 

Ordinary  stoves  provide,  to  a  certain  extent,  for  a  re- 
newing of  the  air  of  the  room,  because  the  air  necessary 
for  combustion  is  drawn  from  the  room  to  be  heated. 
There  results  a  current  of  air  from  the  room  through  the 
fire  chamber  to  the  chimney,  and  fresh  air  from  the  out- 
side enters  through  the  cracks  of  the  doors  and  windows. 

The  self-feeding  stove  is  supplied  with  fuel  for  a  longer 
period.  But  this  must  be  of  a  kind  that  will  not  cake, 


54  PASTORAL   MEDICINE. 

so  that  spaces  may  be  left  through  which  the  air  nec- 
essary for  combustion  can  pass. 

By  means  of  a  regulating  shutter  in  front  of  the  stove, 
below  the  fire  chamber,  the  entrance  of  air,  and  with  it 
the  intensity  of  the  combustion,  can  be  regulated  at  will. 

The  self-feeding  stove  permits  of  the  easy  regulation 
of  uniform  warmth  to  a  room,  as  required  by  the  tem- 
perature outside.  On  the  other  hand,  it  should  not  be 
overlooked  that  the  more  completely  such  stoves  allow  of 
shutting  off  the  draft,  the  greater  becomes  the  possi- 
bility of  fire-damp  (carbonic  oxide)  penetrating  into  the 
room.  Many  a  perfect  and  patented  self-feeding  stove 
has  had  to  be  removed  because  of  the  appearance,  among 
the  occupants  of  a  room,  of  illness  resulting  from  chronic 
poisoning  by  carbonic  oxide  gas. 

Carbonic  oxide  gas,  which  has  already  been  mentioned 
as  a  poisonous  ingredient  of  illuminating  gas,  is  a  color- 
less and  odorless  gas  of  a  nature  extremely  poisonous 
for  the  human  organism.  It  results  from  the  incomplete 
combustion  of  carboniferous  bodies,  and  especially  from 
the  process  of  combustion  in  a  stove.  This  gas  is  also 
commonly  called  fire-damp.  But  this  designation  is  not 
intended  to  apply  to  the  smoke  and  vapor  which  arise 
from  a  fire.  These  last-mentioned  products  of  combustion 
are  intolerable  to  the  senses  and  the  breathing  organs,  and 
people,  therefore,  get  rid  of  them  as  speedily  as  pos- 
sible. 

Carbonic  oxide  also  emanates  from  glowing  coals  after 
the  smoke  has  passed  away.  If  at  this  stage  of  combus- 
tion the  draft  of  the  chimney  is  interrupted  by  means 
of  a  valve  or  shutter,  the  poisonous  gas  enters  the  room 
and  is  most  deadly  for  the  unwary  occupants,  especially 
in  sleep.  The  gas  is  breathed  by  the  lungs,  and  then 
enters  into  combination  with  the  blood,  so  that  the  latter 


HEATING.  55 

can  no  longer  absorb  the  oxygen,  which  is  indispensable 
to  life.  Death  follows  painlessly. 

If  the  quantity  of  gas  breathed  is  not  fatal,  or  the 
victim  is  resuscitated,  there  often  remains  behind  a  per- 
manent impairment  of  health  (mental  debility,  diabetes). 

It  is  not  stoves  alone  that  in  everyday  life  cause  car- 
bonic oxide  poisoning,  but  also  portable  coal-burners, 
which  sometimes  through  inexcusable  carelessness  are 
used  to  heat  closed  rooms.  We  have,  in  our  practice, 
many  times  met  with  cases  where  servant  girls,  who  had 
taken  with  them  into  their  bedroom  an  iron  pot  filled  with 
red  hot  anthracite  and  charcoal,  were,  on  the  following 
morning,  found  dead  or  dying. 

In  order  to  prevent  injury  to  health,  caution  is  also 
necessary  in  the  use  of  apparatus  for  heating  or  cooking 
by  gas.  The  gaseous  products  of  combustion  must  be 
sufficiently  diverted  and  fresh  air  must  be  allowed  to 
enter,  otherwise  a  considerable  accumulation  of  danger- 
ous carbonic  oxide  and  a  lessening  of  oxygen  will  re- 
sult. 

Heating  by  means  of  a  fireplace  is  effected  by  the 
maintenance  of  an  open  fire  in  a  niche  in  the  wall,  with  a 
direct  draft  of  the  products  of  combustion  into  the  chim- 
ney. Fireplaces  are  not  very  common  in  this  country. 
In  England  and  France  they  are  much  in  use.  How- 
ever homelike  a  fireplace  makes  a  room,  it  is  not  a 
practical  method  of  heating,  because  a  far  too  little  part 
of  the  warmth  produced  by  the  fire  is  secured  for  the 
room.  On  the  other  hand,  however,  its  great  value  as  a 
ventilator  for  the  room  must  be  acknowledged. 

As  to  central-heating  apparatus,  the  heat  producer  is 
not  in  the  room  itself,  but  in  another  part  of  the  house, 
commonly  in  the  cellar,  from  which  the  distribution  of 
warmth  in  the  building  is  effected  by  means  of  a  system 


56  PASTORAL   MEDICINE. 

of  pipes.  Belonging  to  this  class  of  apparatus  are  the 
heating  by  hot  air,  by  steam,  and  by  hot  water. 

A  description  of  the  construction  of  these  apparatus 
would  be  too  much  of  a  digression  here,  but  space  may 
be  given  to  a  few  remarks  on  their  advantages  and  dis- 
advantages, since  it  will  be  of  interest  for  thoughtful 
people  to  be  generally  posted  on  these  points.  These  heat- 
ing arrangements  are  also  ordinarily  used  in  large  estab- 
lishments, like  hospitals,  orphan  asylums,  schools,  con- 
vents, etc. 

Heating  by  hot  air  can  be  installed  cheaply,  it  com- 
bines rapidity  of  warming  with  a  certain  continuity.  Its 
greatest  advantage  consists  in  assuring  of  a  constant 
change  of  air  in  rooms,  in  which,  as  far  as  sanitation  is 
concerned,  it  excels  all  other  modes  of  heating. 

The  disadvantages  of  the  hot  air  system  are :  Some  dif- 
ficulty of  regulating  the  supply  of  warmth,  great  con- 
sumption of  fuel,  and  the  danger  of  leakage  or  over- 
heating of  the  apparatus,  and  a  consequent  deterioration 
of  the  quality  of  the  air. 

Great  care  must  be  taken  to  restore  to  the  heated  air 
a  sufficient  degree  of  moisture,  and  this  is  accomplished 
by  the  placing  of  water  within  the  heater,  so  that  its 
steam  mixes  with  the  air  distributed  through  the  pipes. 

Steam  heating  admits  of  wide  distribution,  and  is, 
therefore  largely  in  use  in  big  buildings.  It  is  easy  to 
regulate. 

Disadvantages  of  steam  heat  are :  Costliness  of  installa- 
tion, danger  connected  with  the  management  of  the  boiler, 
the  conductors  easily  become  leaking  and  then  cause  an 
annoying  noise.  Special  contrivances  are  necessary  to 
secure  moisture  to  the  air,  and  also  for  the  changing  of 
air. 

Steam  heating  can  only  exceptionally  be  specially  in- 


VENTILATION.  57 

stalled  in  smaller  dwellings;  while  for  larger  structures 
— for  example,  the  heating  of  hospitals  and  institutions — 
steam  heating  will  always  have  the  preference. 

Hot  water  heating  works  very  rapidly,  is  simple  to 
manage,  and  can  be  easily  introduced  at  a  moderate  cost 
in  buildings  already  existing. 

Its  disadvantages  are  the  great  rapidity  with  which  it 
cools  off,  the  danger  of  freezing,  the  singeing  of  the  par- 
ticles of  dust  that  settle  on  the  pipes,  the  dependence  of 
the  heating  of  different  rooms  on  each  other,  and  hence 
the  difficulty  already  mentioned  of  obtaining  the  tem- 
perature wished  for ;  lack  of  change  of  air. 

This  method  of  heating  is  not  to  be  recommended  for 
dwelling  houses,  but,  on  the  other  hand,  it  is  good  for 
heating  single  subordinate  parts — for  example,  enclosed 
staircases  and  corridors — as  well  as  for  single  large  rooms 
that  have  to  be  used  daily,  such  as  halls  of  all  kinds  and 
restaurants. 

VENTILATION. — Regarding  this  subject,  it  has  already 
been  many  times  mentioned  that  change  of  air  is  necessary 
for  the  maintenance  of  good  health,  while  living  in  closed 
rooms.  Fresh  air  must  be  introduced  and  the  air  already 
used  must  be  expelled.  This  renewing  of  the  air  in  closed 
rooms  we  call  ventilation. 

In  dwelling  rooms  the  natural  circulation  of  air 
through  doors  and  windows  usually  suffices.  In  warm 
weather  the  windows  are  frequently  open,  and  during  the 
season  of  heating,  the  cooler,  fresh  air  penetrates  through 
the  cracks  of  doors  and  windows,  while  the  used-up, 
warmer,  and  therefore  lighter,  air  is  carried  off  through 
cracks  of  the  upper  parts  of  windows  or  through  opened 
transoms.  Air  also  escapes  through  the  stove. 

Tn  larger  rooms,  however,  where  many  people  are 
gathered,  the  natural  circulation  is  often  not  sufficient  for 


58  PASTORAL   MEDICINE. 

a  renovation  of  the  air.  In  these  cases  the  heating  ap- 
paratus is  combined  with  a  ventilating  arrangement,  or 
special  ventilating  shafts  are  installed,  or  other  mechan- 
ical contrivances  are  resorted  to.  The  latter  are  usually 
circular  fans,  placed  in  windows,  and  set  in  rapid  revolu- 
tion. They  are  so  constructed  that  one  captures  fresh  air 
for  the  room  to  be  ventilated,  while  another  expels  the 
used-up  air  in  another  place  (ventilation  by  means  of 
aspiration  and  expulsion). 

PRIVIES. — A  discussion  of  hygienic  requirements  for  a 
perfect  dwelling  can  not  be  dismissed  without  touching 
upon  the  removal  of  human  excrement. 

Every  properly  erected  house  ought  to  have  a  conve- 
nient and  well-arranged  privy.  An  inappropriate  or 
faultily  constructed  privy  renders  the  finest  residence  un- 
comfortable and  dangerous  to  health. 

The  privy,  where  there  are  no  sewers,  ought  to  be 
situated  on  the  side  of  the  house,  where  wind  and  sun 
have  access.  The  room  itself  ought  to  be  sufficiently 
spacious.  The  floor,  walls,  and  ceiling  must  be  smooth 
and  easy  to  clean.  There  should  be  no  living-room  above 
it.  The  opening  of  the  hole  in  the  seat  must  be  closed 
with  a  lid.  The  better  installations  are  those  that  have 
in  the  opening  a  funnel-shaped  trap  of  enameled  iron, 
closed  underneath  by  a  movable  valve.  The  cleansing  of 
the  trap  is  accomplished  by  an  arrangement  of  running 
water. 

The  excremental  matter  falls  into  a  cavity  or  a  remov- 
able receptacle  (barrel,  etc.).  This  cavity  must  be  made 
watertight  on  the  bottom  and  sides.  For  greater  safety 
it  is  recommended  that  a  layer  of  rich  clay  be  pressed 
hard  around  the  sides,  on  the  bottom  of  the  pit,  and 
also  its  enclosing  walls,  in  order  that  the  surrounding 
soil  may  not  become  infected.  The  conduit  to  the  pit 


DRAINAGE.  59 

must  be  on  the  outside  of  the  building,  well  closed,  and 
should  receive  an  additional  cover  of  earth.  In  order 
to  ventilate  the  cavity,  or  cistern,  for  the  purpose  of 
averting  an  accumulation  of  ill-smelling  gases  and  their 
entrance  into  the  dwelling,  it  is  recommended  that  an  air- 
drain  be  arranged  by  leading  a  pipe  from  the  cistern  to  a 
point  above  the  top  of  the  house,  or  at  least  above  the 
highest  windows.  This  pipe,  however,  only  accomplishes 
its  object  if  the  air  in  it  is  warmed,  and  so  is  kept  cir- 
culating. Therefore,  this  drain  pipe  is  placed,  where  pos- 
sible, near  a  chimney. 

In  order  to  keep  a  privy  odorless,  it  is  flushed  with 
water,  where  running  water  is  available,  or  from  time  to 
time  dry  earth  is  thrown  into  the  pit. 

The  cisterns,  as  well  as  removable  receptacles,  require 
to  be  emptied  and  cleaned  from  time  to  time.  The  use  of 
chlorides  is  recommended  to  dispel  gases  and  destroy 
germs. 

In  large  cities  the  refuse  of  the  privies  is  removed  by 
sewers. 

The  drainage  of  cities  consists  of  a  subterranean  net- 
work of  pipes,  connecting  with  the  water  closets  and  sinks 
of  the  houses,  discharging  their  contents  into  larger  pipes 
and  sewers,  and,  by  means  of  a  natural  descent,  into  a 
great  central  reservoir  or  into  some  large  river  near  by. 
If  there  is  no  suitable  large  stream  at  hand,  the  sewage  is 
removed  by  pumps  and  used  for  agricultural  purposes. 
Sometimes  it  is  destroyed  by  cremation. 

Drainage  and  running  water  secured  by  aqueducts  are 
hygienic  arrangements  of  large  cities  that  go  hand  in 
hand. 


60  PASTORAL   MEDICINE. 


Clothing. 

In  considering  clothing  from  a  hygienic  standpoint,  its 
first  object  is  the  regulation  of  the  warmth  of  the  body. 
To  accomplish  this  in  our  climate  we  need  a  considerable 
amount  of  clothing. 

The  materials  of  our  clothing  are  woven  either  out  of 
vegetable  fiber  (cotton,  linen),  or  out  of  the  hair  of  ani- 
mals (wool),  or  out  of  silk  thread.  They  are,  therefore, 
porous,  with  interstices  between  the  individual  fibers. 
The  air  contained  in  these  pores  and  between  the  gar- 
ments plays  an  important  role,  the  effect  of  the  clothing 
being  the  hindering  of  the  escape  of  warmth  generated 
by  the  body. 

The  prevention  of  the  escape  of  warmth  from  the  body 
becomes  essentially  lessened  if  the  clothes  are  wet.  Wet 
clothes,  in  which  the  air  in  the  pores  of  the  material  is 
dislodged  by  water,  conduct  warmth  much  more  readily 
than  dry  clothes  containing  air  in  their  pores.  Further- 
more, the  evaporation  of  the  water  in  the  clothes  pro- 
duces cold,  very  perceptible  to  the  skin. 

For  the  maintenance  of  bodily  well-being,  however, 
the  warming  effect  of  clothing  is  not  alone  decisive. 
There  must  also  be  a  circulation  of  air,  from  the  surface 
of  the  body  through  the  clothing.  Unobstructed  exhala- 
tion of  the  body  is  quite  as  important  for  the  health  as  the 
free  breathing  through  the  lungs.  In  this  regard,  there- 
fore, earnest  consideration  must  be  given  to  the  porosity 
of  clothing.  An  obvious  example  is  rubber  clothing. 
While  retaining  a  great  deal  of  heat,  it  is  quite  unsuitable, 
because  circulation  of  air  is  not  permitted. 

A  third  task  of  clothing  is  the  protection  of  the  surface 
of  the  body  against  the  direct  rays  of  heat,  whether 


CLOTHING.  61 

caused,  in  the  open  air,  by  the  sun,  or  by  artificial  sources 
of  heat. 

Light  colored,  white  or  yellow,  goods  afford  the  best 
protection  against  the  sun's  rays.  If  the  absorbing  power 
of  heat  by  white  material  be  placed  at  100:  that  of  light 
yellow  will  be  102;  of  dark  yellow,  140;  of  light  green, 
152;  of  red,  168;  of  light  blue,  168;  of  black,  208.  Thus 
the  clergyman  with  his  black  clothes  is,  in  this  respect, 
most  unfavorably  situated,  a  misfortune  which  can  be 
somewhat  compensated  by  lightness  of  material. 

Different  parts  of  the  body  demand  special  considera- 
tion in  respect  to  clothing. 

So  the  head,  as  was  mentioned  above  in  our  remarks 
on  sunstroke,  must  be  protected  by  an  airy  and  light  cov- 
ering against  the  rays  of  the  sun.  The  wearing  of  heavy 
head  covering,  which  permits  no  ventilation  to  the  skin 
of  the  head,  causes  dizziness,  perspiration  of  the  head 
and  consequent  wetting  of  the  hair,  injures  the  growth  of 
the  latter  and  causes  it  to  fall  out. 

The  neck,  on  account  of  its  important  blood  vessels  and 
nerves,  must  be  free  from  tight-fitting  clothing.  Other- 
wise there  will  result  congestion  of  the  blood,  rush  of 
blood  to  the  head,  causing  headache  and  injury  to  the 
eyes.  People  should  be  especially  warned  against  the 
use  of  thick  shawls.  They  effeminate  the  neck  and  render 
the  organs  situated  in  this  part  (tonsils,  upper  part  of  the 
throat,  larynx)  unable  to  resist  the  influence  of  weather. 

The  lower  part  of  the  body,  in  times  of  epidemic  ill- 
nesses of  the  digestive  organs  (intestinal  catarrh,  diar- 
rhea, cholera),  should  be  protected  by  a  body  band. 

The  clothing  of  the  feet  requires  particular  care.  Wet 
stockings,  for  instance,  for  the  reasons  already  mentioned, 
cause  colds.  Furthermore,  the  style  of  the  leather  foot- 
covering  must  be  one  fitting  the  structure  of  the  foot. 


62  PASTORAL   MEDICINE, 

Tight  shoes  are  not  only  a  torment  for  the  wearer,  but 
they  also  hinder  the  natural  growth  and  the  circulation 
of  blood  of  the  foot,  and  may  cause  very  painful  and 
annoying  corns  and  ulcers. 

Besides  interrupting  the  regulation  of  warmth,  when  in 
a  wet  condition,  clothes  can  also  cause  illness  in  other  ways. 

It  is  especially  harmful  to  wear  too  many  layers  of 
clothes.  When  a  man  wears  four  or  five  different  clothes, 
one  over  the  other,  there  can  hardly  be  said  to  be  a 
normal  skin  exhalation. 

Colored  garments,  for  instance,  stockings  and  under- 
clothes, can  give  rise  to  skin  diseases  when  the  coloring 
matter  is  poisonous  (aniline  dyes,  colors  made  of  lead). 

Particular  danger  lurks  in  second-hand  clothes,  such 
as  bought  from  old  clothes  dealers.  Many  diseases,  con- 
sumption among  others,  can  be  spread  by  the  wearing  of 
second-hand  clothes.  Where  the  use  of  such  clothing 
must  be  resorted  to,  as  in  asylums  for  the  poor,  etc.,  it 
should  be  worn  only  after  a  thorough  disinfection  in  a 
steam  disinfection  apparatus. 

In  connection  with  a  discussion  of  the  hygienic  purpose 
of  clothing,. the  care  of  the  surface  of  the  body — the  skin 
— must  receive  attention. 

Warm  baths  open  the  pores  of  the  skin,  by  expelling 
dirt  that  gathers  in  them  through  the  mixing  of  perspira- 
tion with  small  particles  shed  by  the  skin  and  minute 
fibers  from  the  underclothing.  Only  then  can  an  evapora- 
tion through  the  skin — or  the  breathing  through  the  skin, 
as  physiologists  say — take  place  in  a  normal  manner. 
The  importance  of  this  operation  for  the  maintenance  of  a 
healthy  body  has  been  shown.  Washing  with  cold  water, 
and  cold  baths,  stimulate  and  harden  the  skin,  so  that 
the  body  becomes  able  to  resist  without  injury  the  in- 
clemency of  weather. 


HYGIENE  OF  SCHOOLS.  63 

A  special  obligation,  also  of  particular  importance  to 
clergymen,  is  the  care  of  the  teeth. 

The  importance  of  good  teeth  for  public  speaking  is 
known ;  everybody  who  has  to  use  his  organ  of  speech 
in  public  is  aware  of  this,  and,  above  all,  the  one  who  has 
defective  teeth.  Besides,  good  teeth  are  needful  for  a 
normal  digestion — all  of  which  is  sufficient  reason  for 
taking  particular  care  of  the  teeth,  without  considering  the 
esthetic  side  of  the  question. 

The  chief  enemy  of  the  teeth  is  a  fungous  growth  which 
is  developed  between  them  by  spittle  mixing  with  remains 
of  food.  It  corrodes  the  enamel  of  the  teeth,  and  grad- 
ually the  substance  of  the  teeth  is  destroyed.  To  prevent 
this,  a  regular  cleansing  of  the  teeth  with  a  good  tooth 
brush  is  necessary.  As  a  tooth  powder,  one  made  out  of 
carbonate  of  lime  and  an  evanescent  oil  (as  the  oil  of 
peppermint)  may  be  recommended.  The  cleansing  of  the 
teeth  takes  place  most  advantageously  before  going  to 
bed,  because  decomposition  in  the  uncleansed  cavities  of 
tfie  mouth  sets  in  most  easily  during  the  night.  The 
tooth  brush  should  be  used  not  alone  in  a  horizontal  direc- 
tion, but  also  vertically,  so  that  the  interstices  between 
the  teeth  may  be  cleaned.  In  order  to  remove  the  tartar 
that  gathers  on  teeth  and  the  dark  color  that  the  teeth 
of  many  smokers  acquire,  a  cleansing  of  the  teeth  by  a 
skilled  dentist,  from  time  to  time,  is  recommended. 

V. — HYGIENE  OF  SCHOOLS. 

Owing  to  the  close  connections  that  exist  between  the 
clergyman  and  the  school,  it  is  evident  that  the  former 
must  be  desirous  to  know  of  the  perils  to  health  that  the 
schools  may  bring. — Mens  sana  in  corpore  sano. 

The  influence  exerted  on  the  child  by  the  school  will 


64  PASTORAL   MEDICINE. 

have  its  effect,  also  in  relation  to  his  body,  not  seldom 
last'ing  all  through  life.  At  no  period  of  life  can  external 
pernicious  influences  result  in  greater  harm  than  at  the 
time  when  man,  though  most  capable  of  training,  is  still 
undeveloped  in  his  organism  and  of  little  force  of  re- 
sistance. It  can  not  be  denied  that  the  perils  to  health  of 
the  school  are  often  exaggerated  by  parents  and  phy- 
sicians. On  the  other  hand,  unprejudiced  observation 
shows  that  many  forms  of  illness  occur  exclusively  among 
children  of  school  age,  for  the  origin  of  which  the  school 
itself  must  be  held  responsible.  We  may,  therefore,  speak 
very  well  of  school  diseases.  These  diseases  are  con- 
tracted partly  through  the  stay  in  school  rooms,  partly 
through  the  deportment  of  the  body  during  tuition. 

Here  belong  congestion  of  the  head,  headache  in  fore- 
head and  back  part  of  the  head,  nose-bleeding,  pulmonary 
diseases,  indigestion,  liver  complaints,  curvatures  of  the 
spine  (sections),  the  latter  especially  frequent  among 
girls.  Ordinary  scoliosis — lateral  bending  of  the  spine : 
one  shoulder  becoming  consequently  higher  than  the 
other — Professor  Virchow  characterizes  directly  as  an 
arrest  in  development  of  the  body  due  to  the  school. 
The  spread  of  contagious  diseases  through  the  school 
should  also  not  be  overlooked. 

Hygiene  of  the  school  concerns  itself,  first  of  all,  with 
the  school  building. 

The  schoolhouse,  like  the  dwelling  house,  must  be 
erected  on  healthy  soil.  It  should  have  an  open  space  all 
around  and  be  situated  as  quietly  as  possible.  The  struc- 
ture must  be  solid,  the  material  without  defect,  and  the 
new  structure  sufficiently  dry  before  occupation.  The 
corridors  must  be  light  and  well  ventilated.  The  stairs 
must  not  be  steep  or  winding  (no  spiral  staircases)  and 
must  be  provided  with  guard  railings. 


HYGIENE  OF  SCHOOLS.  65 

In  the  installation  of  the  water  closets  the  general  sani- 
tary requirements  mentioned  in  the  case  of  dwelling  houses 
are  to  be  observed.  In  the  privies  a  seat  should  be  pro- 
vided for  each  twenty-five  to  thirty  children.  Seats  should 
be  suitable,  not  too  high  nor  too  low.  They  should 
be  separated  by  solid  board  partitions.  The  cleanliness  of 
privies  and  urinals  should  be  severely  insisted  upon. 

As  an  indispensable  requisite,  every  schoolhouse  must 
have  a  playground.  To  every  two  hundred  children  there 
should  be  a  quarter  of  an  acre. 

Furthermore,  the  attention  of  those  concerned  in  hy- 
giene is  directed  to  the  schoolroom  and  its  disposition. 

The  first  and  most  important  condition  for  a  good 
schoolroom  is  its  adequate  size,  which  alone  makes  pos- 
sible the  preservation  of  good  air.  There  may  be  no  fault 
to  be  found  with  all  other  arrangements,  yet  when  the 
requisite  size  of  the  room  is  lacking,  all  other  precautions 
are  in  vain  and  the  health  of  the  scholars  and  teachers 
will  unavoidably  be  undermined. 

Not  more  than  eighty  scholars  should  be  taught  in  one 
class.  The  suitable  ratio  of  length  to  breadth  of  a  school- 
room is  considered  to  be  3  to  2.  For  classes  with  less 
than  fifty  scholars  a  space  approaching  square  size  is 
allowable.  The  length  of  the  room  ought  not  to  be  more 
than  thirty  yards,  its  width  not  more  than  twenty  yards. 
A  clear  height  of  less  than  ten  yards  or  of  more  than  four- 
teen yards  for  the  schoolroom  is  to  be  avoided. 

The  flooring  of  the  ground  floor,  where  there  is  no 
cellar,  must  be  at  least  a  foot  and  a  half  above  the  ground. 
Underneath  should  be  placed  a  layer  of  dry  sand,  or  sifted 
coal  ashes,  eight  inches  thick.  The  floor  should  be  of  oak 
planks,  closely  joined,  and  resting  upon  supporting  beams 
laid  near  together. 

Walls   and   ceiling   must   be  trimmed   smooth.     The 


PAST 


66  PASTORAL  MEDICINE. 

former  should  be  painted  in  a  light  blue,  or  grayish  blue, 
shade ;  the  latter  may  be  calcimined.  Wall  papers  should 
not  be  tolerated  in  school  buildings. 

The  doors  of  the  schoolroom  must  be  at  least  forty 
inches  wide,  must  be  in  plain  sight  of  the  children  (not 
on  a  back  wall)  and  must  open  outward. 

The  light  should  always  fall  on  the  children  from  the 
left  side;  the  windows,  therefore,  must  be  placed  as  suit- 
ably as  possible  for  this  purpose  in  one  of  the  side  walls. 
The  wall  back  of  the  teacher's  chair,  the  opposite  side 
wall,  and  the  wall  back  of  the  children,  should  have  no 
windows.  The  ratio  of  size  of  the  surface  of  glass  in  the 
windows,  to  the  surface  of  the  floor  in  the  room  should  be 
I  to  5  or  I  to  6.  Direct  sunlight  must  be  kept  off  by 
means  of  shades  of  unbleached  linen  or  something  similar. 

These  requirements  regarding  the  light  are  of  decisive 
importance  for  the  prevention  of  short-sightedness.  A 
renowned  oculist  found  in  the  schools  of  a  city,  where 
they  were  situated  in  wide  streets,  1.8  to  6.6%  of  the  chil- 
dren afflicted  with  short  sight;  in  other  schools,  shut 
in  by  high  buildings  and  in  narrow  streets,  tHe  proportion 
was  as  large  as  7.4  to  15.1%. 

In  providing  school  benches  care  should  be  taken  that 
they  afford  to  each  scholar  a  seat  in  accordance  with  re- 
quirements of  health.  As  a  rule,  a  stable  connection  of  desk 
and  bench,  affording  each  scholar  a  width  of  seat  of  about 
two  feet,  is  recommended.  In  each  class  there  are  likely 
to  be  scholars  of  generous  build,  requiring  corresponding 
styles  of  seats,  and  for  all  classes  the  availability  of  four 
different  sizes  of  benches  is  recommended. 

Besides  these  stable  school  benches,  there  are  con- 
structed such  with  independent  desks  or  with  seats  to 
fold  up,  etc. 

The  position  of  the  pupils  on  their  benches,  for  writ- 


HYGIENE  OF  SCHOOLS.  67 

ing  or  reading,  is  of  great  importance  for  the  prevent- 
ing of  bending  of  the  spine. 

In  the  ordinary  faulty  position  of  pupils  the  right 
shoulder  is  raised  and  pushed  forward ;  the  left  hand  rests 
on  the  edge  of  the  desk ;  the  left  arm  is  drawn  back ;  the 
left  shoulder  and  head  are  inclined  toward  the  left  side; 
the  vertebrae  are  turned  about  their  axis  toward  the  right. 
As  a  result,  the  head  rests  no  longer  on  the  spinal  column, 
but,  hanging  forward  and  to  the  right,  it  is  at  first  sup- 
ported by  exertion  of  the  muscles  of  the  neck ;  then,  when 
these  become  tired,  it  supports  itself  by  leaning  against 
the  chest,  which  latter  will  rest  on  the  edge  of  the  desk. 
Thus  the  eyes  are  brought  within  only  a  few  inches  of  the 
writing.  That  such  a  position  must  injure  the  spine,  and 
likewise  the  eyes,  goes  without  saying.  In  an  examina- 
tion of  the  children  of  a  certain  school  it  was  found  that, 
out  of  one  hundred  and  sixty-two  girls  examined,  only 
ninety-two  were  entirely  erect;  while  in  fifty-four  there 
were  found  the  first  stages  of  curvature  of  the  spine.  In 
other  children  the  trouble  was  found  to  have  already 
progressed  further,  and  several  of  them  proved  to  be  in- 
curable. 

The  important  progress  of  general  hygiene,  which  has 
introduced  reforms  relative  to  all  our  functions  of  life, 
and  in  particular  regarding  the  care  of  the  body,  directs 
attention  to  all  those  circumstances  of  school  life  from 
which  proceed  influences  upon  the  health  of  pupils,  and  it 
is  to  be  hailed  as  a  gratifying  result  that  the  care  of  the 
health  of  school  children  now  finds  active  attention  in 
ever-widening  circles. 

Of  course,  many  a  desirable  improvement  must,  for  the 
present,  be  dispensed  with  on  account  of  some  insurmount- 
able difficulty,  which,  however,  makes  it  an  only  more 
pressing  duty  to  painfully  and  conscientiously  take  all 


68  PASTORAL    MEDICINE. 

such  measures  which  circumstances  may  allow  to  be  car- 
ried out. 

Another  important  factor  in  the  care  of  health  in 
schools,  important  also  from  an  educational  point  of  view, 
is  cleanliness.  Especially  injurious  is  the  dust  in  school- 
rooms. It  spreads  the  bacilli  and  causes  the  infection  of 
diseases  of  the  eye,  as  proven  by  medical  authorities.  The 
schoolroom,  with  its  furniture,  must,  therefore,  be  dusted 
often  and  thoroughly.  For  this  purpose  it  is  not  sufficient 
to  sweep  the  schoolrooms  twice  weekly  with  a  dry  broom, 
but  they  must  be  cleaned  each  week  at  least  once  with  a 
wet  mop.  The  dust  every  time  must  be  carefully  removed 
with  a  moist  rag.  Moreover,  where  there  is  room  enough 
it  should  be  arranged  that  wet  overshoes  and  coats  are 
discarded  before  entering  the  schoolroom. 

Finally,  it  may  be  pointed  out  that  out  of  regard  for  the 
eyesight  of  the  pupils  slates  should  be  used  as  little  as 
possible.  In  the  absence  of  a  better  and  more  practical 
medium,  they  can  not  be  entirely  dispensed  with.  Their 
use,  however,  in  schools  with  more  classes  than  one,  should 
in  future  be  confined  to  the  first  two  years.  In  one-class 
and  half-day  schools,  frequented  primarily  by  children 
of  the  poorer  country  population,  it  may,  of  course, 
not  be  possible  to  restrict  the  use  of  the  slates  in  a  like 
manner. 

When  heating  the  schoolrooms  during  the  cold  spell  by 
means  of  stoves  a  pail  of  water  should  be  placed  on  each 
stove  to  keep  the  air  moist.  The  stoves  ought  to  be  in 
good  condition  and  provided  with  a  fire  pot. 


HYGIENE  OF  SCHOOLS.  69 


Protection  Against  Contagion. 

Furthermore,  the  school  plays  an  important  part  in  the 
spreading  of  contagious  diseases  prevalent  with  children, 
especially  measles  and  scarlet  fever. 

Under  the  following  points  we  gather  some  information 
as  to  how  to  protect  as  far  as  possible  the  children  against 
contagion  : 

1.  Diseases  which,  since  easily  contracted,  render  neces- 
sary special  rules  for  schools  include : 

(a)  Cholera,  dysentery,  measles,  rubeola,  scarlet  fever, 
diphtheria,  smallpox,  spilosis,  and  relapsing  fever. 

(b)  Abdominal  typhus,  contagious  inflammation  of  the 
eye,  scabies,  and  whooping  cough  if  acute  and  accom- 
panied by  spasm. 

2.  Children  stricken  with  one  of  the  diseases  enumerated 
under  (a)  or  (&)  are  to  be  excluded  from  frequenting  the 
school. 

3.  The  same  applies  to  children  in  whose  homes  one  of 
the  sicknesses  in  I  under  (a),  mentioned,  occurs,  even  if 
the  children  themselves  be  in  perfect  health.    An  excep- 
tion may  only  be  granted  upon  a  physician's  testimony, 
that  the  child  by  reason  of  thorough  isolation  is  rendered 
safe  from  infection. 

4.  Children  excluded  from  school  for  reasons  set  forth 
in  2  or  3  may  only  be  readmitted  upon  a  physician's  attest 
that  all  danger  of  infection  has  passed  away,  or  after  the 
lapse  of  such  certain  time,  which  by  experience  is  con- 
sidered as  the  normal  duration  of  the  sickness. 

5.  The  normal  duration  of  smallpox  and  scarlet  fever  is 
six  weeks ;  for  measles  and  rubeola,  four  weeks. 

The  child,  and  his  clothes,  should  be  thoroughly 
cleansed  before  he  is  readmitted. 


70  PASTORAL   MEDICINE. 

For  the  enforcing  of  the  rules  2-4  the  head  of  the 
school  (principal,  first  teacher,  director,  or  rector)  is  re- 
sponsible. 

6.  In  boarding-school,  seminaries,  and  the  like,  if  there 
occurs  a  case  of  contagious  disease,  inmates  may,  during 
its  course  or  immediately  thereafter,  be  allowed  to  go 
home,  provided  this  may  be  done,  according  to  the  opinion 
of  a  physician,  without  danger  of  infection,  and  all  nec- 
essary measures  of  precaution,  as  laid  down  by  physicians, 
must  be  complied  with.    Under  the  same  conditions,  chil- 
dren may  be  discharged  on  demand  by  their  parents, 
guardians,  or  foster-parents. 

7.  If  a  person  dwelling  in  the  schoolhouse  be  stricken 
with  one  of  the  diseases  named  under  (a)  and  (b),  or  if  a 
person  living  in  the  same  house  with  one  of  the  school- 
teachers be  stricken  with  one  of  the  diseases  as  named  in 
i  (a),  the  head  of  the  family  must  immediately  inform 
the  school  board.    The  patient  must  be  placed  in  quaran- 
tine.   The  civil  authorities  are  to  decide  whether  or  not 
the  school  is  to  be  closed,  and  what  sanitary  measures 
should  be  taken.     This  rule  applies  also  to  boarding 
schools. 

8.  If  several  cases,  as  in  I,  appear  in  the  locality  of  the 
school  or  its  environs,  principal  and  teachers  have  to  pay 
particular  attention  that  the  schoolhouse  is  kept  clean  and 
that  the  rooms  are  well  ventilated.    Especially  the  class- 
rooms and  the  toilets  must  be  thoroughly  cleaned  every 
day,  which  work  must  not  be  performed  by  school  chil- 
dren. 

The  classrooms  must  be  constantly  ventilated,  also  after 
school  hours;  and  the  closets  must  be  regularly  disin- 
fected. 

9.  The  closing  of  schools  or  single  classes  is  decided 
upon  by  the  civil  authorities  in  consultation  with  the  of- 


THE  INFIRMARY.  71 

ficial  physician.  In  case  of  imminent  danger,  the  school 
board  and  the  local  police  have  the  power  to  close  on  the 
strength  of  any  physician's  opinion. 

10.  The  reopening  of  a  school  or  class,  closed  on  account 
of  a  contagious  disease,  must  be  preceded  by  a  thorough 
cleaning  and  disinfecting  of  the  schoolrooms.  The  re- 
opening can  only  be  ordered  by  the  civil  authority,  the 
official  physician  concurring. 

VI. — THE  INFIRMARY. 

Another  public  institution  which  offers  a  field  for  the 
clergyman  is  the  hospital.  As  pointed  out  in  the  preface, 
hospitals  and  hospices  were  founded  in  the  first  Christian 
centuries  by  the  Church. 

General  epidemics  (pestilence,  black  death,  pox,  lep- 
rosy) led  to  the  erection  of  numerous  plague-houses.  The 
Church  at  all  times,  through  its  servants,  has  maintained 
and  supported  such  institutions  wherever  she  was  able. 

Even  to-day  there  are  many  places  where  the  clergyman 
is  a  member  of  the  board  of  managers  of  an  infirmary, 
and  it  behooves  him  to  know  the  principal  sanitary  re- 
quirements. 

It  goes  without  saying  that  a  building,  wherein  patients 
are  to  regain  their  health,  must  stand  on  dry,  clean  soil 
and  be  provided  with  good  drinking-water.  It  ought  to 
be  situated  in  an  open  and  quiet  neighborhood.  In  man- 
ufacturing towns  the  vicinity  of  factories  and  shops  ought 
to  be  avoided.  The  dimensions  of  the  site  depend  on  the 
number  of  patients  for  whom  the  hospital  is  destined. 

If  possible,  the  estimate  should  include  the  laying  out  of 
a  garden.  Wherever  possible  hospital  and  ground  space 
should  allow  two  hundred  square  yards,  or  at  least  one 
hundred  square  yards,  for  each  patient. 


72  PASTORAL   MEDICINE. 

To  each  bedstead  is  to  be  allotted  a  space  of  eight  to  ten 
square  yards,  an  air  space  of  thirty  to  sixty  cubic  yards, 
and  a  light  space  (in  windows)  of  one  and  a  half  to  two 
and  a  half  square  yards.  Length,  width,  and  height  of 
rooms,  also  the  number  of  windows,  may  be  calculated 
from  the  foregoing  dimensions. 

For  the  supply  of  direct  sunshine,  which  every  sick 
man  greatly  needs,  is  of  importance  not  only  the  number 
and  the  size  of  the  windows,  but  also  their  location.  They 
must  be  placed  so  advantageously  that  they  are  reached  by 
the  sun  through  the  greater  part  of  the  day  and  the  most 
part  of  the  year.  They  are  to  be  provided  with  blinds. 

All  rooms  in  the  hospitals,  especially  the  sick-rooms, 
ought  to  be  well  provided  with  good  fresh  air,  which 
can  be  achieved  by  ventilation  and  good  mechanical  cleans- 
ing. Should  the  natural  ventilation  prove  insufficient  to 
replenish  the  air,  then  air  pumps  are  to  be  used.  Of 
material  importance  is  the  prompt  removal  of  excretion 
and  sputum,  and  the  sweeping  away  of  the  dust  with  a 
moist  mop  or  rag. 

In  preserving  good  air  the  mode  of  heating  and 
lighting  plays  no  small  part.  Steam  heat  is  preferable  to 
the  ordinary  stove,  and  the  electric  light  to  gas  or  kero- 
sene, for  the  latter  consume  oxygen  and  produce  car- 
bonic acid. 

In  order  to  meet  all  exigencies  for  a  hospital,  the 
builder  of  a  hospital  has  the  choice  of  three  systems: 
the  corridor,  the  pavilion,  and  the  barrack  systems. 

The  corridor  system,  representing  the  uniform  hospital, 
is  especially  adapted  for  small  infirmaries  with  from  ten 
to  one  hundred  beds.  The  sick-rooms  are  all  adjacent, 
and  have  only  one  window-wall ;  the  doors  open  into  the 
corridor,  which  ought  to  be  lighted  by  numerous  win- 
dows. 


THE  INFIRMARY.  73 

Apart  from  the  main  building,  and  only  connected  with 
it  by  a  passageway  leading  from  the  ground  floor,  is  the 
building  containing  kitchen,  laundry,  etc.  Only  in  this 
way  can  the  patients  be  spared  the  vapor  and  odor  from 
these  places. 

As  far  apart  as  possible  from  the  other  sick-rooms,  are 
the  rooms  for  delirious  and  insane  patients;  also  an 
isolated  room  for  contagious  diseases,  if  a  special  building 
for  such  diseases  can  not  be  obtained. 

Every  hospital  should  have  a  morgue,  for  the  dead 
bodies  should,  for  various  reasons,  not  be  kept  within  the 
institution  itself.  In  the  morgue  building  may  be  located 
the  disinfecting  room — likewise  indispensable  for  every 
hospital.  There  the  disinfecting  apparatus,  worked  by 
steam,  may  be  placed. 

In  contrast  with  the  corridor  system,  which  assembles 
all  patients  in  one  building,  are  the  barrack  and  the 
pavilion  systems,  which  scatter  them. 

The  barrack  contains  a  large  sick  room,  room  for  the 
nurses,  isolating  rooms,  the  scullery,  baths,  and  water- 
closets.  The  beds,  as  a  rule,  are  placed  in  two  rows, 
separated  by  a  spacious  passageway.  The  ceiling  is 
formed  by  slanting  roofing,  the  ridge  of  which  is  raised 
and  provided  with  window-blinds,  which  let  the  bad  air 
escape  and  admit  fresh  air. 

The  plan  of  sick  room  and  outbuilding  is  the  same 
in  the  pavilion  system  as  in  the  barrack.  In  the  former 
system,  however,  there  is  no  ridge  ventilation,  and  there 
must  be  special  ventilating  appliances.  On  the  other 
hand,  it  admits  of  the  erection  of  two  or  three  story  build- 
ings. In  larger  institutions  these  sick  rooms — barracks 
or  pavilions — are  linked  to  a  central  building  containing 
the  offices,  kitchen,  laundry,  etc. 


74  PASTORAL   MEDICINE 

VII. — DEATH.     ASPHYXY.     SIGNS  OF  DEATH. 
MANNERS  OF  DEATH.     BURIAL. 

When  all  the  organs  of  the  human  body  have  definitely 
ceased  to  work,  then  death  has  set  in. 

The  transition  from  life  to  death  may  be  sudden,  even 
in  people  of  good  health;  for  instance,  in  case  of  death 
by  lightning,  by  sunstroke  or  apoplexy,  by  crushing  or 
laceration,  by  bullet  wounds,  during  childbirth  or  con- 
finement, while  undergoing  difficult  operation,  in  some 
cases  of  poisoning,  or  through  grave  interior  hemor- 
rhages, of  the  brain  for  instance,  or  of  the  lungs.  In 
such  cases  of  death  pose  and  facial  expression  of  the 
dead  remain  exactly  as  they  were  in  his  last  moments; 
whereof  every  battlefield  furnishes  proof,  likewise  the 
inquest  over  suicides.  Generally,  however,  death  comes 
more  or  less  gradually,  and  is  heralded  by  preceding  signs. 
The  stage  in  which  these  signs  occur  is  called  death- 
struggle  or  agony. 

The  last  phase  of  life  of  a  person  has  been  called  a 
struggle,  because  it  often  shows  symptoms  of  excitement, 
particularly  of  pains  and  spasms,  and  because  it  was  taken 
to  be  the  last  stand  of  the  principle  of  life  against  the 
threatening  annihilation.  On  the  other  hand,  many  peo- 
ple, especially  those  of  advanced  age,  pass  away  very 
quietly  and  without  pain.  The  strength  of  the  body  has 
nothing  to  do  with  the  agony.  The  strongest  apoplectic 
may  die  without  struggle,  while  the  most  emaciated  con- 
sumptive suffers  for  hours  and  days,  so  that  the  ancients 
said  of  these  afflicted,  "  Non  moriuntur,  sed  extinguuntur 
sicuti  elychnium  deficiente  oleo." 

The  agony  in  all  cases  presents  a  mixture  of  the 
symptoms  of  the  death-causing  malady  and  of  the  signs 


DEATH.  75 

of  the  progressing  paralysis  of  the  nerves  and  muscles. 
The  different  organs  of  the  body  die  off  in  a  certain 
almost  regular  order. 

Consciousness,  if  present  in  agony,  survives  the  senses. 
It  seems  as  if  scent  and  taste  disappear  first.  Then 
vanishes  the  sight.  Dying  people  complain  frequently  of 
a  fog  in  front  of  their  eyes,  or  cry  for  light.  Their  hear- 
ing, however,  is  responsive  to  impressions  even  after  the 
eye  is  already  surrounded  by  darkness.  The  attention  of 
the  bystander  should  be  called  to  this  fact,  lest  any  in- 
cautious remarks  be  made.  The  faculty  of  feeling  re- 
mains sometimes  to  the  last  moment.  The  dying  feel  the 
cold,  which  gradually  extends  from  the  periphery  of  the 
body  to  the  inner  parts. 

The  exterior  muscles  are  the  ones  to  first  lose  the 
faculty  to  obey  the  will.  The  sinews  contract,  but  are  un- 
able to  move  the  limbs.  The  body  slides  downward  in 
the  bed;  the  limbs,  obeying  the  law  of  gravitation,  fall 
down  powerless  if  raised.  The  features  begin  to  appear 
drawn,  the  underjaw  drops,  the  eyelids  sink,  but  do  not 
close.  In  prolonged  agony,  the  coat  of  the  eye  becomes 
red.  The  patient  is  unable  to  fix  the  eye  upon  an  object ; 
the  cornea  loses  its  luster  and  becomes  dull.  The  temples 
shrink.  The  nose  becomes  pointed  and  seems  elongated. 
The  nostrils  are  caved  in.  The  whole  face  seems  longer. 
The  outlines  of  the  jawbones  stand  out  sharply,  owing  to 
the  relaxed  muscles.  The  chin  is  pointed  and  protruding. 
The  lips  are  dry,  the  complexion  yellowish  or  bluish ;  the 
skin  is  cool,  covered  with  cold,  sticky  perspiration.  The 
picture  sketched  is  called  fades  Hippocratica. 

Breathing  is  slow,  with  long  intervals  and  difficult.  The 
respiration  is  uneven.  After  some  superficial  drafts,  the 
patient  breathes  deeply.  The  tracheas  are  filled  with 
phlegm,  which  no  longer  can  be  expectorated  by  coughing. 


76  PASTORAL   MEDICINE. 

The  air,  breathed  in  and  out,  produces  in  the  phlegm  of 
the  bronchia  a  rattling  sound,  that  can  be  heard  at  a  dis- 
tance— the  death-rattle.  The  contraction  of  the  heart  be- 
comes weaker,  there  is  less  blood  in  the  arteries ;  the  pulsa- 
tion grows  smaller;  the  beats  can  no  longer  be  counted, 
nor,  finally,  felt. 

Has  a  sick  person  offered  the  foregoing  symptoms,  one 
is  justified  to  pronounce  him  dead  after  respiration  ceases 
entirely. 

Asphyxy,  or  apparent  death,  is  a  condition  in  which 
the  functions  of  life,  while  not  entirely  ceasing,  fail  to 
manifest  themselves  outwardly.  Loss  of  consciousness, 
of  feeling,  even  of  the  animal  heat,  are  incidents ;  only 
the  faculty  of  hearing  is  sometimes  normally  retained. 
This  death-like  state  may  endure  for  hours,  even  for  a 
few  days. 

That  a  minimum  of  animation  suffices  to  protect  organic 
matter  from  decay,  is  proven  by  the  plants  in  winter  time, 
by  insects  while  in  the  state  of  chrysalis,  particularly  by 
animals  in  their  winter  sleep. 

From  its  causes  there  are  distinguished  different  kinds 
of  asphyxy : 

1.  Asphyxy  from  interior  illness:  A  deep  swoon  after 
exhaustion  by  a  fatiguing  and  prolonged  march,  after  a 
difficult  delivery,  after  prolonged  starvation   (as  in  the 
case  of  shipwrecked  and  insane  persons),  from  vehement 
spasms,  in  cases  of  hysteria,  epilepsy,  and  eclampsy,  from 
Asiatic  cholera  in  asphyctic  stage,  from  some  forms  of 
yellow  fever,  typhus,  tetanus,  children's  cramps,   from 
asthma  and  asthmatic  spasms,  from  poisoning  by  opium, 
prussic  acid,  chloroform. 

2.  Asphyxy  from  exterior  troubles:  From  extensive 
and  heavy  contusions  received  by  heavy  corporal  punish- 
ment (whipping  post),  grave  concussions  of  the  brain, 


ASPHYXY.  77 

particularly  after  an  explosion,  from  dangerous  and 
numerous  wounds  resulting  in  a  large  loss  of  blood,  large 
loss  of  blood  by  women  in  childbed,  and  by  little  children. 

3.  Asphyxy  from  specific  causes.  Asphyxy  from  irre- 
spirable  gases  (inhalation  of  sulphuric  and  sulphurous 
vapors,  of  nitric  acid  and  muriatic  vapors,  of  ammonia  and 
chloric  gases);  asphyxy  of  new-born  babies;  asphyxy 
from  drowning,  hanging,  strangulation,  from  stroke  of 
lightning,  from  heat,  from  rarefaction  of  air  (lack  of 
oxygen),  from  suffocation  or  being  buried  under  wreck- 
age, etc.,  from  foreign  substances  in  mouth  or  larynx. 

Asphyxy  is  entitled  to  particular  attention  because  of 
the  possibility  of  burying  alive  an  only  apparently  dead 
person. 

Although  the  burying  alive  of  a  person  is  stated  by  the 
ignorant,  and  in  sensational  literature,  to  be  of  not  rare 
occurrence,  it  must  be  admitted  that  the  instances  in 
which  this  has  been  proved  are  exceedingly  rare. 

The  safest  way  to  avoid  any  mistake  as  to  death  hav- 
ing set  in  is  to  wait  for  the  sure  sign  of  death.  The  prema- 
ture burial  of  corpses,  even  aside  from  legal  reasons,  is  a 
practice  to  be  condemned. 

The  means  by  which  asphyxy  can  be  distinguished 
from  real  death,  some  of  which  will  at  the  same  time  serve 
for  reviving  purposes,  are  as  follows: 

i.  Respiration  and  the  movements  of  the  heart  con- 
tinue in  asphyxy,  though  in  a  minimal  degree;  whereas 
they  cease  entirely  if  death  has  really  set  in.  To  ascertain 
their  presence  a  small  feather  or  a  lighted  candle  should  be 
held  under  the  nose,  or  a  small  vessel  filled  with  water  is 
placed  in  the  cardiac  region  and  its  movement  observed, 
or  a  cooled  looking-glass  held  close  to  the  mouth  to  see 
whether  it  shows  any  moisture  from  breath. 

Furthermore,  the  muscle  activity  is  stimulated  by  smell- 


78  PASTORAL   MEDICINE. 

ing-salts  (spirits  of  sal-ammoniac),  by  tickling  the  nose, 
by  irritating  the  skin  with  spirits  of  mustard,  dropping 
burning  sealing  wax  on  the  skin,  sprinkling  with  cold 
water  or  pouring  it  over  the  body. 

2.  Apply  mustard  plasters  or  rub  the  skin  sore  in  some 
places  with  a  wet  flannel  or  with  brushes,  till  the  epidermis 
is  removed;  if  death  has  set  in,  the  places  whereon  the 
poultice  has  been  applied  do  not  become  red,  nor  do  the 
parts  rubbed  show  any  exudation,  but  dry  up  soon  and 
assume,  after  six  to  twelve  hours,  a  yellow-brownish  color 
of  a  horny  and  somewhat  transparent  appearance. 

3.  Spots  of  a  bluish  red  hue  (livores  mortis)  appear 
generally  eight  to  twelve  hours  after  death,  first  on  the 
lower  surface  of  the  corpse,  i.  e.,  if  it  lies  on  its  back,  then 
on  the  back ;  if  face  down,  on  the  face,  the  chest,  and  the 
abdomen. 

4.  One  of  the  most  decisive  signs  of  absolute  death  is 
the  rigor  of  the  muscles.    It  begins  in  the  lower  jaw,  in 
throat  and  neck,  extends  down  the  trunk  to  arm  and  leg, 
and  disappears  in  the  same  order.    As  a  rule,  the  rigor 
sets  in  from  four  to  twelve  hours,  sometimes,  but  very 
rarely,   after  twenty-four  hours,   or   already   in   a   few 
minutes  after  death.     The  muscles,  those  that  bend  or 
stretch  the  limbs,  become  compact,  shortened,  and  swollen, 
the  same  as  when  contracted  in  life. 

5.  The  ending  of  the  rigor  coincides  with  the  be- 
ginning of  decay,  which  reveals  itself  by  a  cadaverous 
smell,  by  a  greenish  color  of  the  skin,  beginning  in  the 
lower  abdominal  parts,  and  by  developing  of  gases  in  the 
cavities  of  the  body  and,  later  on,  beneath  the  skin. 

Infallible  signs  that  death  has  taken  place,  are,  there- 
fore, in  the  first  place,  rigor  and  decay;  in  the  second 
place,  the  livores  (spots),  the  nature  of  preceding  illness, 
and  the  agony. 


MANNERS   OF  DEATH.  79 

The  manner  of  death  varies  according  to  the  organ 
which  has  caused  the  death.  The  organs  through  which 
the  stimulus  of  life  is  fed  to  the  rest  of  the  body  are: 
Lungs,  heart,  and  the  brain,  with  the  spinal  cord.  On 
account  of  their  importance  for  life,  they  were  called  by 
the  ancients  "  Atria  mortis." 

Generally  three  different  manners  of  death  are  assumed : 
i.  Death  from  the  brain  (mors  per  apoplexiam).  2.  Death 
from  the  respiratory  organs  (mors  per  asphyxiam). 
3.  Death  from  the  heart  (per  syncopem).  It  is  very 
rarely  that  these  modes  of  death  occur  absolutely,  and 
then  only  by  sudden  death.  Mostly,  and  in  case  of  slower 
death  almost  always,  a  combination  of  the  three  modes  has 
taken  place;  for  instance,  prevented  respiration  changes 
the  composition  of  the  blood  and  hinders  its  circulation 
in  the  brain  and  spinal  cord;  this  again  hampers  the 
respiration  and  the  activity  of  the  heart. 

Judiciary  medicine,  whose  chief  duty  it  is  to  reveal 
to  the  criminal  courts  a  forcible  manner  of  death,  dis- 
tinguishes the  following  modes  of  death : 

i.  Suffocation  by  hanging,  throttling,  choking,  drown- 
ing, and  other  ways,  cutting  off  the  breathing  with  cloth 
or  by  hand,  etc.  2.  By  bleeding  to  death.  3.  Death  by 
starvation.  4.  Death  by  burning  or  scalding.  5.  Death  by 
freezing.  6.  Death  from  poisoning. 

It  is  beyond  the  scope  of  the  present  book  to  describe 
even  only  superficially  the  symptoms  of  these  modes, 
especially  as,  though  important  in  deciding  a  case,  they 
are  by  no  means  determining,  so  that  it  is  often  difficult 
for  the  experts,  who  hold  the  inquest,  to  establish  the 
cause  of  death  after  the  autopsy. 

The  dead  human  body,  the  corpse,  according  to  natural 
laws,  soon  decays,  decomposes,  and  thereby  may  imperil 
the  health  of  the  surviving.  The  removal  and  burial  of 


8o  PASTORAL   MEDICINE. 

corpses  was,  with  all  nations,  one  of  the  first  hygienic 
measures  ever  taken. 

The  most  common  kind  of  burial  is  the  interment.  The 
first  mention  of  burying  in  an  earthen  grave  is  made  in 
Gen.  xxiii.  3.  Abraham  purchased  ground  from  the  chil- 
dren of  Heth  to  bury  Sarah  there.  Heth's  children,  there- 
fore, must  have  known  the  practice  of  burying  the  dead. 
All  fire  worshipers  buried  their  dead;  likewise  the 
Buddhists;  whereas  the  Brahmins  practise  cremation. 
Those  of  the  Japanese,  who  are  the  offspring  of  Bud- 
dhists that  settled  there  about  1200  B.  C,  still  bury  their 
dead ;  whereas  cremation  is  practised  to  this  very  day  by 
the  aboriginal  inhabitants,  who  follow  the  teachings  of 
Kami. 

The  Chinese  invariably  bury  their  dead.  It  is  known 
that  their  scattering  of  the  graves  not  only  is  a  menace  to 
public  health,  but  has  offered  the  chief  obstacle  for  the 
building  of  railroads  in  China. 

The  ancient  Greeks  both  buried  and  cremated.  Burying 
seems  to  have  been  the  more  common  practice,  as  indi- 
cated by  the  many  terms  of  the  Greek  language  for  bury- 
ing in  the  soil. 

T<tyof  from  8airTEiv  signifies  funeral,  burial,  and  death 
meal.  (Homer  Ilias  25,  619,  680;  Odyssea  3,  309; 
4,  547.)  Homer  also  uses  the  verb  for  cremating  (with- 
out irvoi,  Odyssea  12,  12;  24,  417,  and  Ilias  21,  323),  for 
the  entombment  of  the  bones  collected  in  urns  and  their 
burial  in  a  grave  of  clay  (Odyssea  n,  52).  At  a  later 
period  the  verb  was  generally  used  for  the  burial  of  the 
corpse ;  just  as  the  Roman  sepulchrum  was  used  both  for 
the  burying  of  the  uncremated  corpse  as  well  as  for  the 
interment  of  the  ashes. 

The  Evangelists  use  but^/w  or  ^w^Zov,  only  Matthew, 
when  referring  to  the  Pharisees,  uses  T<tyof. 


BURIAL.  8 1 

<rvf/Muf»  in  distinction  from  the  brick  tomb, 
means  a  natural  rent  or  hollow  in  a  rock,  which  was  used 
for  burying  purposes,  as,  for  instance,  the  grave  wherein 
the  younger  Xicodemus  had  the  Saviour  entombed. 

Sepultus,  according  to  Pliny,  means  any  corpse  buried 
in  a  grave,  whether  the  whole  corpse  or  only  his  inciner- 
ated remains.  Humatus  is  used  by  the  same  author  for  a 
corpse  interred  in  a  dug  pit,  and  covered  up  with 
earth. 

The  first  Christians  buried  their  dead  in  the  common 
graveyards,  but  apart  from  the  heathen.  Pressed  by  the 
persecutions  of  the  Roman  emperors,  the  Christians  in 
Rome  were  soon  compelled  to  bury  their  members  in  stone 
caves.  The  burial  in  graves  was  at  all  times  the  custom 
of  the  Church,  and  it  is  the  only  one  which  she  allows.  In 
recent  years  cremation  in  specially  constructed  furnaces 
has  come  into  practice  again.  It  is,  however,  prohibited 
by  the  Church. 

The  process  of  decomposition  of  the  buried  corpse  is 
completed  in  from  six  to  nine  months.  The  cavities  of  the 
body,  even  the  strong  skull,  burst  from  the  pressure  of  the 
gases  formed.  The  soft  parts  liquefy,  flow  through  the 
coffin  and  ooze  into  the  surrounding  soil.  This  has  caused 
much  apprehension ;  but  there  is  no  danger  of  contamina- 
tion if  the  cemetery  is  properly  managed.  The  process  of 
decomposition  of  corpses  is  so  gradual  that  the  living  can 
not  possibly  be  endangered  or  annoyed.  No  specific  poison- 
ous gases,  as  formerly  erroneously  assumed,  are  formed. 
The  emanating  malodorous  putrescent  gases  are  absorbed 
by  the  soil  so  thoroughly  that  even  during  an  exhuma- 
tion a  smell  is  rarely  noticeable. 

Buried  corpses  can  not  spread  a  disease,  for  the  reason 
that  the  infectious  bacilli  can  not  escape  from  under 
ground.  In  the  course  of  putrefaction  they  are,  moreover, 


8a  PASTORAL   MEDICINE. 

soon  destroyed  by  bacteria  of  decomposition.  As  a  fact, 
there  are  no  accredited  statistical  proofs  for  a  greater 
mortality  or  more  frequent  infections  among  people  dwell- 
ing in  the  vicinity  of  cemeteries. 

In  cases  of  exception,  the  corpse  in  his  grave  does  not 
decompose,  but  mummifies.  The  corpse  dries  up,  main- 
taining his  exterior  form. 

Mummification  occurs  in  case  of  poisoning  by  arsenic 
or  sublimate,  also  under  certain  local  conditions,  as  where 
there  is  cold,  sharp,  drying  air  present  in  the  vaults.  Such 
conditions  prevail  in  a  monastery  of  the  Capuchins  near 
Palermo,  in  the  monastery  on  Mount  St.  Bernard,  and 
at  other  places. 

In  order  to  avoid  danger  to  health,  and  annoyance  to 
living  people,  the  following  rules  should  govern  in  the 
laying  out  and  running  of  cemeteries : 

The  ground  should  be  open  and  elevated.  The  pious 
practice  of  our  ancestors  of  building  the  cemetery  around 
the  church  must  be  disapproved  of,  for  sanitary  reasons. 
Sandy  soil,  possibly  mixed  with  loam,  is  best.  The  under- 
ground water  must  be  at  a  considerable  distance  from  the 
surface,  lest  the  bottom  of  the  graves  be  reached  by  the 
water.  Dwelling  houses  should  be  at  least  ten  yards 
from  the  cemetery ;  wells  at  least  fifty  yards,  if  the  under- 
ground water  flows  toward  the  wells.  The  suitable  dimen- 
sions for  a  grave  are  two  and  a  half  yards  by  one  yard. 
Between  two  graves  there  should  be  a  space  of  at  least  a 
half  yard.  For  the  graves  of  adults  a  period  of  twenty- 
five  years  should  be  allowed,  for  those  of  children  one  of 
twenty  years.  Local  conditions,  the  character  of  the  soil, 
the  state  of  putrefaction  as  observed  in  exhumed  remains 
may  justify  a  departure  from  the  average  period.  Par- 
ticular precaution  is  required  in  making  a  second  layer  of 
corpses,  made  necessary  sometimes  through  lack  of  space 


CEMETERIES.  83 

and  through  a  large  increase  of  the  congregation.  The 
second  series  of  graves  will  not  be  dug  the  full  depth, 
but  only  far  enough  to  reach  about  the  coffin  below. 
The  mound  must  be  earthed  up  as  high  as  possible,  and 
the  acquisition  of  a  new  cemetery  at  the  earliest  possible 
time  should  be  insisted  upon. 

The  erection  of  buildings  on  old  cemeteries  is  only  ad- 
visable at  least  forty  years  after  the  last  burials. 

Trees  may  be  advantageously  planted  in  cemeteries  in 
use,  but  not  too  near  together,  lest  the  circulation  of  air 
be  obstructed. 

If  it  is  foreseen  that  the  present  space  of  a  cemetery 
will  not  remain  equal  to  the  demand,  or  if  it  should  entail 
some  danger  to  health  which  can  not  be  obviated  by  im- 
provements, then  the  religious  or  political  communities, 
who  are  to  care  for  the  interment,  should  in  time  look 
out  for  a  new  cemetery,  or  the  enlargement  of  the  old  one, 
lest  the  acquisition  of  a  suitable  ground  be  prevented  by 
the  building  of  dwelling-houses. 

Concerning  the  interior  disposition  and  the  manage- 
ment of  cemeteries,  the  following  is  recommended : 

1.  A  cemetery  should  be  at  a  distance  of  at  least  two 
hundred  yards  from  the  outskirts  of  the  town  or  village. 
In  each  particular  case,  however,  it  requires  a  thorough 
examination  whether  that  distance  is  safe,  or  whether 
possibly  a  shorter  distance  be  permissible. 

2.  The  cemetery  should,  if  possible,  be  on  a  higher  level 
than  the  residences  in  the  neighborhood.  Conditions  being 
equal,  grounds  situated  to  the  north  or  east  of  the  town 
or  settlement  should  be  preferred. 

If  drainage  is  necessary,  as,  for  instance,  in  case  of 
moist  soil,  low  or  slanting  ground,  vicinity  of  wells  and 
waterway,  or  to  prevent  water  from  flowing  into  the  ceme- 
tery, then  a  suitable  ditch  is  to  be  dug  at  the  proper  places. 


84  PASTORAL   MEDICINE. 

The  burial  ground  must  be  fenced  in,  by  dense,  if  pos- 
sible, thorny  bushes  at  least  one  yard  high,  or  by  a  brick 
wall,  or  a  strong  wooden  fence  of  at  least  one  and  a  half 
yards  high.  There  must  be  at  least  one  gate,  that  may  be 
shut  or  locked,  and  large  enough  to  allow  vehicles  to  enter. 

3.  Plants  should  be  fostered  on  cemeteries,  but  they 
must  not  keep  the  sun  from  the  graves.  Shade  trees  should 
only  be  planted  on  broad  walks,  and  at  due  distance  from 
one  another.    Fruit-bearing  trees  and  poplars  should  not 
be  planted  at  all.    Of  plants  those  of  the  evergreen  kind 
are  to  be  recommended. 

The  fields  must  be  leveled,  covered  with  turf,  and  sep- 
arated by  roadways,  covered  with  gravel  or  sand.  Be- 
tween the  rows  of  graves  there  must  run  a  pathway  lead- 
ing to  the  graves. 

In  towns  and  larger  places  the  erection  of  a  vault  for 
the  dead  should  be  advocated,  where  the  corpses,  especially 
of  those  who  died  from  a  contagious  disease,  or  of 
unidentified,  may  be  received  and  cared  for  in  a  safe  and 
dignified  way ;  where  parties  at  a  funeral  may  find  shelter 
in  inclement  weather  and  where  the  coroner's  autopsy 
may  be  held. 

Monuments  upon  graves  must  be  preserved  in  good 
condition  by  the  owner,  as  long  as  he  has  a  claim  upon 
the  plot  on  which  it  stands. 

Monuments,  in  designs  and  inscriptions,  should  conform 
with  the  views  of  the  Church.  Care  should  be  taken  that 
inscriptions  may  not  cause  offense  by  their  contents. 

4.  Gravediggers  are  to  be  employed  at  certain  wages. 
The  following  rules  for  the  gravediggers  are  to  be 

recommended : 

(a)  The  grave  should  have  a  depth  of  two  yards,  suf- 
ficient length  and  width,  to  receive  the  coffin  without 
hindrance. 


CEMETERIES.  85 

(&)  The  placing  of  the  coffin  in  graves  containing 
water  or  mud  is  inadmissible. 

(c)  In  exceptional  cases,  if  made  necessary  by  rocky 
ground  or  the  presence  of  water,  the  coffin  may  be  buried 
nearer  the  surface;  the  cover  must,  however,  be  at  least 
one  yard  under  the  surface. 

(d)  Each  grave  must  be  separated  from  the  next  by 
an  upright,  strong  earthen  partition  of  at  least  a  half 
yard. 

(tf)  To  bury  two  or  more  corpses  in  one  grave  is  only 
permissible,  if  the  sanitary  regulations  covering  such  cases 
can  be  complied  with.  Under  all  circumstances  must  it 
be  insisted  upon  that  the  uppermost  coffin  is  at  least  one 
yard  under  the  surface. 

In  cases  of  emergency,  as  in  the  time  of  epidemics,  the 
local  board  of  health  will  take  charge  of  these  matters. 

(/)  As  a  rule  a  period  of  twenty-five  years  is  to  be 
allowed  to  a  grave,  before  put  to  use  again.  Local  con- 
ditions, that  tend  to  accelerate  or  retard  decomposition, 
may  make  a  modification  of  this  period  necessary. 

(g)  If,  in  digging  a  grave,  not  fully  destroyed  parts  of 
a  corpse  or  coffin  are  found,  they  have  to  be  lowered  under 
the  bottom  of  the  new  grave ;  if,  however,  whole  corpses 
not  decomposed  are  found,  then  the  graves  must  be  filled 
up  immediately  and  left  alone. 

(h)  Each  new  grave  must  be  marked  by  the  digger  on 
the  map  and  numbered.  The  grave  must  bear  the  cor- 
responding number. 

(t)  The  gravedigger  shall  keep  a  book  containing  the 
full  name,  birthday,  day  of  burial,  and  the  number  of 
grave  of  every  person  buried  in  the  cemetery. 

It  is,  of  course,  necessary  that  a  certain  rotation  of 
graves  is  observed.  Moreover,  the  one  in  charge  of  the 
cemetery  must  be  well  acquainted  with  any  variation  in 


86  PASTORAL   MEDICINE. 

the  nature  of  the  soil  occurring  in  the  cemetery  ground 
that  may  necessitate  special  measures  of  precaution. 

A  "  Potter's  Field  "  for  paupers,  unknown  persons,  and 
criminals,  may  also,  in  many  instances,  have  to  be  pro- 
vided for. 


SECOND    PART. 


PASTORAL   MEDICINE. 

The   Relation    of  Man  in  His  Bodily  Conditions  to 
Religion  and  Morality. 

O INCE  times  immemorial  man,  in  his  thirst  for  knowl- 
edge, has  questioned :  Whence  do  I  come  ?  The  query 
is  answered  in  a  scientific,  historical  sense  by  anthropology 
— a  science  of  only  recent  date,  devoted  to  the  natural 
history  of  man  and  his  position  in  the  order  of  organic 
life. 

For  a  time  it  seemed,  at  least  to  prejudiced  investi- 
gators, as  if  anthropology  would  leave  the  Christian  doc- 
trine of  the  creation  of  man,  and  of  his  history,  without  a 
leg  to  stand  upon.  It  soon  became  a  favorite  theory  that 
man,  by  natural  evolution,  had  risen  from  the  lower  order 
of  organic  beings  and  that  he,  in  a  certain  way,  was  but 
the  final  link  of  the  animal  order.  His  next  kin  were  the 
man-like  simians.  In  the  opinion  of  these  scientists,  there 
exists  a  greater  breach,  in  physical  and  mental  respect,  be- 
tween the  civilized  Caucasian  and  the  uncivilized  savage, 
than  between  the  latter  and  the  most  human-like  ape. 

To  support  this  view,  the  fossil  man  was  enlisted.  The 
remains  of  primitive  man,  as  found  within  the  geological 
formation  of  the  diluvial,  were  proclaimed  to  point  to  a 
man  entirely  different  from  the  one  that  lives  to-day.  The 
missing  link  between  man  and  ape  had  been  found. 

All  these  deductions  in  favor  of  the  materialistic  theory 
of  origin  of  man,  however,  soon  proved  visionary.  Sober 
observers,  thorough  investigators,  in  interpreting  ana- 

87 


88  PASTORAL   MEDICINE. 

tomical  and  paleontological  discoveries,  arrived  at  dif- 
ferent results.  It  was  proved  that  primitive  man  was 
not  essentially  different  from  the  human  generation  of 
to-day. 

The  exact,  anthropological,  science  not  only  brings  to 
light  nothing  contradictory  to  the  Christian  doctrine  of 
the  creation  and  unity  of  origin  of  mankind,  but  fur- 
nishes even  supporting  evidence  for  it. 

If  the  unbelieving,  but  honest,  scientist,  when  con- 
fronted by  the  question  about  origin  of  man,  confesses 
his  "  Ignoramus,"  then  the  believer  finds  consolation  and 
information  in  the  words  of  Moses :  "  And  God  created 
man  to  his  own  image." 

However  interesting  these  scientific  contemplations  of 
the  history  of  mankind  may  be,  an  exhaustive  treatise  of 
this  subject,  of  the  relation  between  nature  and  revelation, 
would  vastly  transgress  the  scope  of  this  work. 

Therefore,  we  turn  to  the  individual  Man,  to  investi- 
gate his  various  stages  of  life  in  their  relation  to  the  Cath- 
olic religion  and  morality.  And  here  the  genesis  of  the 
individual  claims  our  first  attention. 

I. — PROCURATIO  ABORTUS. 

Procreation  is  the  impregnation  of  the  female  ovary-cell 
by  the  copula  carnalis.  The  embryo  or  fetus  develops  in 
the  womb  until  the  end  of  the  fortieth  week.  Then  able 
to  live  outside  the  womb,  it  is  discharged  by  the  act  of 
delivery,  and  is  born  a  full-time  child.  The  premature  in- 
terruption of  the  life  of  the  fetus  in  the  uterus  and  its  dis- 
charge from  the  womb  are  called  abortion. 

Abortion  may  be  spontaneous,  i.  e.,  without  traceable 
mechanic  or  dynamic  cause  (miscarriage) .  Diseases  of  the 
procreators,  or  of  the  ovum,  may  be  the  causes,  especially 


PROCURATIO   ABORTUS.  89 

constitutional  syphilis.  The  dying  off  of  the  fetus,  owing 
to  syphilis,  within  the  first  months  is  very  frequent, 
whether  the  father  or  mother  be  the  diseased  party.  This 
kind  of  abortion,  not  important  for  moralists  and  crimi- 
nalists, does  not  interest  us  as  much  as  the  purposely  inter- 
rupted pregnancy  by  mechanical  and  dynamical  means. 
A  wilful  abortion  is  tantamount  to  destroying  a  human 
being — it  is  murder. 

With  conception  the  foundation  is  laid  for  the  perfect 
man,  only  he  vegetates  in  his  beginning  among  surround- 
ings different  from  those  of  his  future  life.  The  conten- 
tion of  St.  Thomas  that  the  anima  rationalis  appears  only 
toward  the  end  of  the  intra-uteral  life  is  repudiated  as 
erroneous  by  theologians  and  jurists.  According  to  the 
order  of  natural  laws  given  by  the  Creator,  the  act  of 
procreation  is  a  single  one.  By  this  act  body  and  soul  are 
called  into  existence.  Even  simple  observation  suggests 
this  theory.  With  the  act  of  procreation  mental  and 
physical  qualities  of  the  procreators  are  imprinted  upon 
the  future  human  being.  The  hereditary  endowment,  or 
the  hereditary  fatal  evil  inclination,  is  present. 

Criminal  abortion  is  practised  by  pregnants,  both  un- 
married and  married.  The  former  are  driven  by  shame 
to  this  sinful  manipulation ;  but  it  is  also  not  uncommon 
for  married  people  to  take  recourse  to  this  reprehensible 
means  to  escape  the  burden  of  providing  for  children. 

With  uncivilized  and  savage  nations  abortion  is  a  com- 
mon practice  and  one  of  the  reasons  for  their  extinction. 
That  this  crime  is  practised  in  strata  of  society  that  claim 
to  belong  to  the  most  cultured,  transpires  from  time  to 
time  from  the  records  of  the  criminal  courts. 

The  question  arises,  To  what  extent  is  abortion  per- 
missible in  medical  practice?  The  moralists  teach: 
"  Nunquam  licet  directs  procurare  abortum" 


90  PASTORAL   MEDICINE. 

The  ancients  were  quick  to  resort  to  abortion.  In 
ancient  Rome  professional  abortionists  were  quite  com- 
mon. Christianity  counteracted  this  criminal  practice,  as 
well  as  everything  heathen. 

Modern  obstetrics  and  gynecology  know,  in  fact,  only 
two  conditions  where  abortion  enters  into  question  as  a 
last  resort.  They  are  the  incarceration  of  the  pregnant 
womb  in  the  small  pelvis,  and  uncontrollable  vomiting  of 
the  pregnant. 

Viewed  from  the  Catholic  standpoint,  is  the  operation 
under  such  conditions  permissible  or  not? 

The  Holy  Office  has  decided  that  under  no  circum- 
stances is  abortion  permissible.  This  decision  has  been 
severely  criticised  by  the  medical  fraternity,  but  to  the 
believer  it  is  the  only  consistent  course.  An  excellent  and 
exhaustive  statement  of  this  question,  and  a  convincing 
defence  of  the  Catholic  position,  is  found  in  the  recently 
published  book,  "  The  Right  to  Life  of  the  Unborn  Child," 
by  Professor  H.  Treub  et  al.* 

If  miscarriage  has  taken  place,  the  human  being  at  this 
early  stage  of  development  will  become  an  object  for 
pastoral  care.  Any  living  embryo  is  a  human  being.  An 
unbaptized  person  can  not  enter  the  kingdom  of  heaven. 
Nisi  quis  renatus  fuerit  ex  aqua  et  Spiritu  Sancto,  non 
potent  introire  in  regnum  Dei. 

It  is  undoubtedly  the  duty  of  the  parties  next  con- 
cerned to  baptize  a  fetus  upon  its  discharge.  The  term 
"  next  concerned,"  or  present,  recalls  the  preception  of 
the  Rituale  Rom. :  "Pater  aut  mater  propriam  prolem  bap- 
tisare  non  debent,  praeterquam  in  mortis  articulo,  quando 
alius  non  reperitur,  qui  baptizet." 

The  fruits  at  the  first  period  of  pregnancy  are  always 

* ' '  The  Right  to  Life  of  the  Unborn  Child,"  etc.  Published  by 
Joseph  P.  Wagner,  New  York. 


PROCURATIO   ABORTUS.  91 

"  in  mortis  articulo,"  in  most  cases  death  has  set  in  before 
the  birth.  For  this  reason  I  hold  that  a  fetus  just  dis- 
charged, if  not  more  than  five  months  old,  should  only  be 
baptized  sub  conditione. 

In  the  case  of  a  miscarriage  in  the  first  months  the 
fetus,  at  the  very  first,  is  parted  from  its  feeder,  the  wall 
of  the  womb.  This,  at  first,  hinders,  and  eventually  en- 
tirely checks,  the  supply  of  the  indispensable  arterial 
blood  from  the  blood  vessels  of  the  mother.  In  view  of 
the  slight  development  of  the  tissues  and  organs  of  the 
fetus,  it  is  out  of  question  to  assume  that  it  can  survive 
for  even  a  moment  the  withdrawal  of  that  element  of  life. 
Considering  further  that  there  is  an  interval  between  the 
time  when  the  fetus  parts  from  its  feeder  and  the  time  of 
ejection,  one  may  safely  assume  that  these  fruits  are  dead. 

The  view  taken  by  some  that  the  fetus  is  almost  always 
discharged  alive,  or  that  it  frequently  lives  thereafter  for 
twenty-four  hours,  is  erroneous.  The  possible  existence 
of  life  might  be  assumed  when,  after  a  short  travail,  the 
fetus  with  the  membranes  would  be  quickly  discharged. 
In  that  case  there  would  be  no  objection  to  baptism  by 
immersion,  sub  conditione,  after  bursting  the  membranes. 

I  often  was  reminded  of  the  words  of  Our  Lord,  "  Cast 
not  pearls  before  the  swine,"  when  in  my  practice  I  have 
seen  how  midwives  perform  the  act  of  christening  on 
discolored,  putrid  fetus  or  shreds  of  membrane.  It  like- 
wise impairs  the  dignity  of  the  clergy  to  expect  of  the 
priest  to  look  for  and  christen  the  fetus  after  miscarriage. 

The  priest  will  have  fulfilled  his  duty  by  requiring  those 
concerned  to  conditionally  christen  any  fresh  fruit  of  the 
body,  born  after  a  short  travail.  The  holy  rite  should, 
however,  not  be  performed  on  putrid  fetuses  or  tissues. 


92  PASTORAL   MEDICINE. 


II. — BIRTH — CARE  OF  THE  CHILD. 

Through  the  act  of  birth  the  mature  fruit  is  dis- 
charged and  the  independent  life  of  the  individual  begins. 
Though  a  natural  event,  birth  stands  upon  the  borderlines 
between  physiological  and  pathological  conditions  of  the 
body.  There  may  occur  at  any  moment  a  turn  into  sick- 
ness. Birth  being  a  matter  of  several  lives,  it  is  only 
natural  that  pastoral  care  is  largely  interested  in  this  event, 
especially  because  the  newborn — sometimes  there  are 
more  than  one — has  not  yet  been  christened.  On  account 
of  the  danger  attached  to  childbirth  for  the  mother,  it  is 
a  good  Catholic  custom  that  she  partake  of  the  holy  Sacra- 
ments shortly  before  delivery. 

During  the  delivery  various  things  may  happen  to  put 
the  mother's  life  in  jeopardy.  In  first  place,  the  cramps 
of  parturient  women  (Eclampsia  parturientium} . 

In  this  condition  the  woman  in  labor  is  suddenly  thrown 
into  general  spasms ;  the  face  gets  contorted ;  trunk  and 
limbs  are  in  convulsions.  The  child  may  yet  be  in  the 
uterus  or  be  born  already.  The  physician  must  act 
promptly  and  energetically  to  avoid  a  fatal  result.  After 
the  first  attack,  the  Sacraments  should  be  administered  to 
the  patient,  for  there  is  generally  a  repetition  of  attacks, 
followed  by  loss  of  consciousness,  and  often  by  death 
from  apoplexia. 

Another  condition  of  sickness  with  a  mortal  tendency 
are  hemorrhages  during  or  after  delivery.  The  cause 
for  one  kind  of  these  hemorrhages  is  an  aberration  of 
nature,  disastrous  for  mother  and  child  alike :  the  irregular 
seat  of  the  placenta  in  the  lower  section  of  the  womb,  in 
front  of  the  child.  The  mother  must  receive  the  last 
rites  in  this  instance.  This  precaution  should  also  be 


BIRTH— CARE  OF  THE  CHILD.  93 

taken  in  any  case  where  the  childbirth  requires  the  use  of 
instruments  or  of  operation. 

The  matter  in  question  for  the  child  is  the  administra- 
tion of  baptism.  According  to  the  teachings  of  the 
Church,  everybody  may  christen  in  case  of  need.  If  the 
child  infra  partum  is  in  danger  of  life,  then  midwife  or 
physician  is  bound  to  perform  the  rite. 

First,  the  question  is  to  be  settled  whether  or  not  the 
child  can  be  validly  christened  while  in  the  womb.  The 
necessity  for  this  baptism  arises  always  when  an  opera- 
tion dangerous  for  the  fruit  is  to  be  performed.  Gury 
asserts  the  validity  of  this  baptism,  as  being  quite  evident. 
Is  one  of  the  limbs  of  the  child  developed,  then  baptism  is 
administered  thereon.  According  to  the  rules  of  the 
Church,  the  baptismal  water  must  touch  the  body  of  the 
child  to  be  baptized,  the  enveloping  membranes  must  there- 
fore be  opened.  On  the  head  the  administering  of  baptism 
may  be  aspersione  or  ablutions,  by  a  versed  hand,  perhaps 
also  with  a  clean  syringe,  if  the  ablution  by  the  finger 
dipped  in  water  should  be  regarded  insufficient,  although 
Gury  holds  it  to  be  sufficient.  Midwives  should  by  no 
means  be  advised  to  apply  a  syringe  for  that  purpose, 
because  there  is  danger  of  injuring  and  infecting  the 
womb,  which  may  lead  to  childbed  fever.  I  mention 
this  because  Gury  speaks  of  christening  in  that  manner. 

It  transpires  from  the  above  statement  that  baptism  is 
invalid  if  administered  to  a  child  which,  though  born, 
is  yet  surrounded  by  membranes.  The  exterior  mem- 
brane comes  from  the  mother,  and  is,  therefore,  no 
part  of  the  child.  Therefore,  it  was  necessary,  while 
speaking  of  the  baptism  of  the  fetus  in  the  first  months, 
to  demand  the  bursting  open  of  the  membranes.  The 
administering  of  baptism  on  the  navel  string  is  likewise 
inadmissible,  it  being  no  direct  part  of  the  child. 


94  PASTORAL   MEDICINE. 

Brief  mention  is  here  to  be  made  of  abnormal  fruits. 
These  misformations  of  the  wonderful  structure  of  the 
human  body  die  soon  after  birth.  Being  undoubtedly 
human  beings,  they  should  be  christened  forthwith.  It 
may  serve  as  a  rule  that  arty  fruit  possessing  head  and 
breast  may  and  should  be  christened.  The  rare  deformity 
of  acardiacus  consists  only  of  a  kind  of  trunk  and  rudi- 
ments of  limbs.  It  occurs  in  cases  of  pregnancy  with 
twins,  and  can  not  be  considered  as  an  individual. 

Cart  of  the  Child. 

Every  mother,  capable  thereof,  is,  according  to  natural 
law,  in  duty  bound  to  nurture  the  child  herself.  It  is  for 
the  physician  to  judge  whether,  in  view  of  conditions,  she 
should  be  dispensed  from  that  duty.  Too  many  women 
shirk  this  duty  for  trifling  reasons,  fondness  of  pleasure, 
vanity,  etc.  The  next  and  most  natural  substitute  is  a 
wet-nurse.  In  engaging  a  wet-nurse  not  only  her  bodily 
qualities  are  to  be  considered,  but  also  her  mental  and 
moral  qualities.  The  adage  says  rightly  of  a  character 
trait  it  was  fed  to  its  owner  with  the  mother's  milk. 

There  is  another  drawback  to  wet-nursing.  The  own 
child  of  the  nurse,  if  alive,  is  intrusted  to  the  care  of 
another  woman.  Statistics  prove  only  too  clearly,  with 
fearful  figures,  how  mortality  ravages  among  these  foster- 
children. 

In  ancient  times  the  father  had  the  right  to  decide 
over  life  or  death  of  the  newborn  child.  Abortion,  aban- 
doning, or  killing  newborn  babes  were  not  considered 
criminal  deeds.  Only  under  the  influence  of  Christianity 
it  was  realized  that  even  the  helpless  newborn  are  beings 
endowed  with  the  right  to  live.  Already  the  very  first 
fathers  of  the  Church  have  declaimed  with  impressive 


CARE    OF    THE    CHILD.  95 

words  against  these  crimes  against  the  immature  human 
being,  or  the  one  who  has  just  stepped  into  existence. 

On  part  of  the  state,  Emperor  Constantine  made  infanti- 
cide a  capital  crime.  It  was,  furthermore,  decreed  that 
the  state  should  provide  for  abandoned  children. 

In  the  following  centuries  it  was  the  Church  exclusively 
who  championed  abandoned  children.  Many  churches 
on  the  Rhine  and  in  Gaul  were  provided  with  marble  re- 
ceptacles in  front  of  their  doors.  The  children  deposited 
therein  were  intrusted  to  the  care  of  worthy  people.  The 
first  home  for  foundlings  was  established  by  Archbishop 
Datheus,  of  Milan,  where  foundlings  received  at  the 
church  doors  were  taken  in,  cared  for  by  wet-nurses,  and 
raised  up  to  their  eighth  year.  By  and  by  similar  homes 
were  founded  in  Italy,  France,  Spain,  and  Portugal.  Most 
of  them  were  under  direct  supervision  of  the  bishops.  In 
the  seventeenth  century  the  state  again  began  to  attend  to 
the  improvement  of  social  and  sanitary  conditions  of  these 
children.  The  caretaking  of  these  poor  and  abandoned 
children  in  homes  for  foundlings  is  called  the  Roman 
system;  whereas  their  intrusting  to  the  care  of  foster- 
mothers  is  called  the  German  system,  there  being  no 
foundling  homes  in  Germany.  After  this  brief  historical 
deviation,  let  us  return  to  our  starting  point. 

The  infant  leads  at  first  a  vegetating  existence,  not- 
withstanding this  its  mental  faculties  develop  with  the 
increasing  growth. 

The  chief  requirements  for  the  welfare  of  the  youthful 
body  are  a  healthful  nourishment,  fresh  air,  and  a  good 
care  of  the  body,  especially  of  the  skin. 

Special  attention  must  be  directed  here  to  a  nuisance, 
which  at  present  is  spreading  more  and  more,  to  the 
detriment  of  the  little  ones.  I  refer  to  the  misuse  of 
alcohol  in  the  child's  sphere. 


96  PASTORAL   MEDICINE. 

It  is  nothing  uncommon  to  meet  a  mother,  who,  in  her 
anxiety  for  the  growth  of  the  child,  gives  it  a  rich  wine, 
so  that  it  may  grow  strong.  She  has  no  physician's  pre- 
scription to  show  to  warrant  the  use  of  strong  alcoholic 
wine.  The  pernicious  results  of  the  misuse  of  alcohol  at 
an  early  age  have  been  stated  in  an  excellent  manner  by 
the  late  Dr.  R.  Demme,  for  years  chief  physician  of  the 
hospital  for  children  at  Berne. 

One  of  the  most  common  and  injurious  mistakes  in 
raising  children  is,  according  to  Demme,  to  let  them  par- 
take regularly  of  alcoholic  beverages.  Ill-placed  kind- 
ness, thoughtlessness,  also  wrong  impressions  of  the  hy- 
gienic influence  of  alcoholic  drinks  upon  the  organism  of 
the  child,  cause  the  parents  to  let  the  children  share  in 
such  drinks. 

The  injurious  effects  of  the  misuse  of  alcohol  on  grown 
people  appear  also  on  the  organism  of  children,  only 
sooner  and  to  a  larger  degree.  Immediate  consequences 
are  indigestion  of  all  sorts,  nervous  disorders,  especially 
the  notorious  nervosity.  Primarily  it  leads  to  drunken- 
ness itself,  which  is  directly  nurtured  by  the  habit,  inas- 
much as  the  stimulation  to  which  the  child  gets  early 
accustomed  requires  more  and  more  to  be  satisfied. 

"  We  must  endeavor,"  says  Dr.  Demme,  "  to  keep  chil- 
dren from  using  alcoholic  beverages  as  a  drink.  It  is  the 
physician's  duty  to  enlighten  rich  and  poor  in  respect  to 
the  danger  lurking  for  children  in  the  early  use  of  alco- 
holic drinks." 

This  concerns  the  habitual  use  of  alcohol  by  healthy 
children.  It  is  an  entirely  different  matter  when  the  sick 
child  for  a  time  being  is  given  alcoholic  beverages  on 
prescription  by  and  under  supervision  of  a  physician, 
when  unavoidable  in  the  treatment  of  children's  ailments. 

I  know  of  two  cases — both  from  the  practice  among 


THE   CHILD  AT  SCHOOL  'AGE.  97 

the  poor — where,  at  a  festivity,  children  three  and  five  years 
of  age  became  intoxicated  by  whisky.  They  became  idiotic 
immediately  after  disappearance  of  the  severe  symptoms 
of  intoxication,  stupor,  etc. 


The  Child  at  School  Age. 

At  the  age  of  six  years  the  child  must  go  to  school.  The 
prevention  of  injury  to  health  while  at  school  was  dis- 
cussed in  the  first  part,  under  the  heading  "  Hygiene  in 
Schools." 

The  attention  of  the  pastor  may  be  called  to  those 
among  the  school  children  who  present  a  deviation  from 
the  normal :  the  stuttering  and  feeble  minded. 

Stuttering  results  from  an  imperfect  influence  of  the 
will  upon  the  muscles  and  organs  of  speech.  Words  or 
sentences  can  only  be  uttered  after  repeated  efforts,  some- 
times accompanied  by  a  jerk  or  a  convulsion  of  the  entire 
face.  The  trouble  is  intensified  by  embarrassment  and 
anxiety.  It  is,  therefore,  quite  common  that  a  stuttering 
child  is  never  cured  in  a  public  school  from  his  defect. 

A  special  exercise  is  here  required  for  the  group  of 
muscles  active  in  the  formation  of  sound  and  in  speaking. 
Improvement  or  cure  can  only  be  derived  from  taking  a 
course  for  the  healing  of  stuttering,  or  from  a  stay  at  an 
institution  where  this  trouble  receives  methodical  treat- 
ment. If  the  priest  fails  in  this  case  to  enlighten  by  word 
and  advice,  this  defect  will  often  be  regarded  as  a  bad 
habit  and  be  left  to  itself.  More  aggravated  is  the 
condition  of  children  mentally  weak.  These  beings  are 
a  hindrance,  yet  the  weak  mental  faculty  which  they 
possess  can  be  developed.  Convincing  proofs  thereof  are 
the  results  gained  in  institutes  for  idiots.  If  a  mentally 


98  PASTORAL   MEDICINE. 

stunted  child  remains  with  his  family,  there  is,  as  a  rule, 
no  progress  to  be  expected ;  it  remains  stationary  on  the 
step  of  its  arrested  development.  Such  is  its  fate,  es- 
pecially, if  it  belongs  to  the  poorer  populace,  and  if  the 
pastor  does  not  intervene  in  its  behalf. 

In  such  cases  the  prejudices  of  the  parents  can  often 
be  overcome  only  with  great  difficulty. 

The  hygienic  aspect  of  the  Church  law,  which  binds 
the  person  in  good  health,  from  his  seventh  year  on,  to 
abstain  from  meat  on  certain  days  in  the  year,  has  already 
been  discussed. 


III. — MATRIMONY. 

Development  of  sexual  maturity  begins  with  the  four- 
teenth year,  sometimes  sooner  or  later.  It  is  especially  the 
sexual  instinct,  the  most  powerful  human  instinct  besides 
auri  sacra  fames,  which  requires  the  particular  attention 
of  the  priest.  The  strange  bodily  functions  which  appear 
at  this  stage  of  life  incite  attention,  cause  at  first  innocent 
touch,  but  may  readily  clear  the  path  for  vice,  if  the  fear 
of  God  is  wanting. 

The  only  legitimation  of  sexual  intercourse  is  matri- 
mony, and  the  main  purpose  of  marriage  is  the  propaga- 
tion of  mankind. 

We  refrain  for  obvious  reasons  from  discussing  at  this 
place  the  materia  turpis  of  the  moralists,  which  the  clergy- 
man finds  amply  treated  in  his  Latin  handbook  on  Moral 
Theology.  Some  space  should,  however,  be  given  here  to 
one  of  the  impediments,  the  Impedimentum  Consangui- 
nitatis,  since  it  has  an  important  bearing  upon  hereditary 
oneration,  of  which  there  is  such  frequent  mention  made 
in  the  following  chapters. 


IMPEDIMENT   OF   CONSANGUINITY.      99 

Impedimentum  Consanguinitatis. 

The  establishment  of  consanguinity  and  its  grades  is 
a  task  for  the  canonical  matrimonial  law.  Natural  science 
furnishes  the  reasons  for  the  prohibition. 

The  law  of  Moses  already  forbade  marriage  between 
kinsfolk.  In  the  early  restrictions  made  in  this  direction 
stress  is  laid  more  upon  the  moral  principle  violated  by 
such  unions  than  of  the  harmful  consequences  resulting 
therefrom.  This  is  especially  the  case  in  the  law  of  Moses, 
and  the  impediment  is  consequently  not  based  upon  an 
idea,  or  the  will  of  the  lawgiver,  but  it  is  even  considered 
as  self-evident  and  demanded  by  morality. 

The  effects  of  a  violation  of  this  natural  law,  as  already 
observed  at  an  early  time,  are  confirmed  by  investigations 
in  modern  times.  Such  marriages  in  nearly  all  cases 
result  in  corporal  defects  of  the  offspring:  of  five  chil- 
dren born  in  kindred  wedlock,  one  only  is  normal.  Most 
disastrous  for  the  progeny  are  marriages  consummated 
between  the  immediate  offspring  of  two  sisters.  Less 
dangerous  proves  marriage  between  the  son  of  the  brother 
and  the  daughter  of  the  sister,  and  vice  versa.  Still  less 
danger  lies  in  marriage  between  the  children  of  two 
brothers.  These  three  grades  of  consanguinity  are  the 
most  hazardous  for  the  offspring. 

In  a  lecture  on  marriage  between  cousins  Darwin,  re- 
ferring to  the  investigations  by  his  father,  says : 

1.  Consanguinity  of  the  parents  is  injurious  for  their 
children. 

2.  Where  children  seem  to  remain  exempt,  the  injury 
may  appear  in  the  grandchildren. 

3.  These  unions  are  more  a  source  of  idiocy  and  dullness 
than  of  the  forms  of  madness. 


ioo  PASTORAL   MEDICINE. 

The  first  question  contained  in  the  application  form 
for  admittance  of  a  patient  to  a  public  insane  asylum 
reads:  Were  the  parents  or  grandparents  of  the  patient 
blood  relations,  and  in  what  degree?  Which  tends  to 
show  that,  according  to  modern  psychiatry,  consanguin- 
ity plays  a  paramount  part  among  the  causes  for  mental 
disorders. 

According  to  Bauregard,  there  resulted  ninety-five  chil- 
dren from  seventeen  investigated  intermarriages  between 
blood  relatives.  Of  these,  twenty-four  were  idiots,  one 
deaf,  one  a  dwarf,  thirty-seven  tolerably  normal,  the  rest 
in  good  health.  In  forming  the  embryo,  the  procreative 
cells,  male  and  female,  come  together;  consequently,  the 
fruit  in  building  up  its  parts  can  but  follow  one  or  the 
other  of  the  parents.  In  so  far  as  it  takes  after  the  father, 
it  must  cease  to  be  like  the  mother,  or  vice  versa.  In  this 
way,  by  prevalence  on  one  part,  the  entirely  healthy  let  us 
assume,  the  influence  of  the  other,  perhaps  weaker  part, 
may  be  counterbalanced. 

As  a  matter  of  fact  we  know  crossing  of  races  as  a 
means  of  preventing  degeneration ;  whereas,  as  it  is 
known,  certain  family  traits  and  family  diseases  are  carried 
to  the  extreme  by  continued  intermarrying  among  kins. 
Especially  is  it  known  that  cretinism  and  idiocy  are  spread 
by  marriages  among  blood  relatives,  and  checked  by  mar- 
riages with  persons  of  another  stock  or  country. 

The  same  applies,  though  in  a  lesser  degree,  to  deaf 
and  dumbness. 

The  marriage  of  blood  relatives  results  also  often  in 
sterility,  or  abortion,  or  in  sickness  among  the  progeny, 
especially  in  an  impaired  vitality  and  in  deformities.  A 
commission,  with  Dr.  Morris  as  chairman,  has  investi- 
gated the  subject  and  published  the  following  table  (New 
York,  1859)  : 


CELIBACY. 


101 


a> 

m 

a 

-- 

O 

*•  bo 

•-  o 

0  Jf 

c.  £ 

C  ol 

•  a 

•  O  v  fi 

KINSHIP 

II 

•°2 

V  V 

i| 

c-^au 

s-g 

2-a 
•=0 

2^ 

S'sS'S 

o 

o 

O  o 

Pu 

Cousins  of  third  degree  

I* 

71 

42 

2Q 

40  8 

"         "   second     "      

1  20 

626 

360 

266 

"         "  first         "      

6  TO 

2QII 

oee 

TQRfi 

67.2 

Descendants  of  cousins  

6l 

IS? 

64 

6c.7 

Uncles  and  aunts  with  neph- 

ews and    nieces  

12 

ers 

16 

,n 

81  i 

Double  cousins  

27 

21 

1^1 

06.  j. 

Incest  in  its  full   sense  

IO 

,x 

I 

06.  i 

IV. — CELIBACY. 

The  Catholic  Church  demands  celibacy  of  her  priests. 
Ever  since  the  great  Gregory  has  carried  out  his  principle : 
"  non  liber ari  potest  ecclesia  a  servitute  laicorum,  nisi 
liberantur  clerici  ab  uxoribus"  to  this  very  day,  has  this 
institution  of  the  Church  been  vehemently  assailed.  The 
preeminent  justification  of  celibacy,  the  dogmatic,  is  here 
beyond  discussion.  A  main  objection  is  the  following: 
Celibacy  is  impossible;  therefore  immoral.  Let  it  be 
answered  by  an  unbiased  and  unobjectionable  obser- 
ver: 

"  We  have  already  mentioned  how  essentially  the  sexual 
impulse  differs  from  all  other  instincts,  and  how  and  why 
it  lacks  the  unconquerable  character  peculiar  to  the  rest. 
No  other  instinct,  therefore,  can  be,  and  is,  bridled  to  such 
an  extent  by  reason  and  morality  than  the  sexual  im- 
pulse "  (Dr.  Casper). 

By  pledging  celibacy,  the  rule  of  the  will  becomes  sup- 
ported and  fortified  by  supernatural  motives.  The  im- 
portance of  education  is,  furthermore,  not  to  be  under- 
rated. Abstinence  decreases  the  libido  sexualis.  The 


102  PASTORAL   MEDICINE. 

Church,  therefore,  rightly  pays  great  attention  to  the 
training  of  her  clergy.  Professor  Schreyer,  of  Halle,  a 
Protestant,  in  his  manual  of  Pastoral  Medicine,  says 
anent : 

"  Without  weighing  the  reasons  for  or  against  such  a 
Church  law,  i.  e.,  votum  castitatis,  it  is  only  the  question, 
Hew  is  it  best  kept  by  young  teachers  of  religion? 
First  of  all,  pains  must  be  taken,  already  in  the  semi- 
naries, for  raising  young  men  for  the  clergy,  that  they 
may  be  fitted  out  with  such  physical  qualities,  besides  re- 
ligious and  moral,  that  they  may  be  able  to  ply  their  voca- 
tion without  hindrance,  and  to  keep  a  law  which  to  violate 
is  offensive  enough.  Hence  no  one  should  be  ordained  a 
priest  without  having  been  trained  to  morality  and  in- 
tegrity by  piety,  temperance,  work,  and  good  example, 
or  without  having  been  subjected  to  extensive  trials, 
both  physical  and  moral." 

At  any  rate,  the  experience,  gleaned  in  the  centuries 
since  this  institution  exists  in  the  occidental  Church, 
teaches  that  it  is  just  the  celibacy  which  imparts  to  the 
Catholic  priest  the  authority  and  dignity  indispensable  for 
his  vocation. 

Even  the  bitterest  opponents  of  this  clergy  must 
admit  that  in  regard  to  morality  no  stone  can  be  thrown 
at  it,  may  the  stooping  down  to  pick  one  up  be  ever 
so  easy. 

Besides,  there  are  many  more  reasons  which  speak  in 
favor  of  this  law.  Matrimony  would  be  a  hindrance  for 
the  priest  in  exercising  his  office  at  the  sick-bed,  in  the 
confessional,  in  mission  work. 

Simply  for  the  sake  of  their  historical  interest,  not  be- 
cause they  are  valid,  we  touch  upon  the  objections  against 
celibacy  as  being  injurious  to  health. 

From  Jovinianus  the  Monk  (388)  opposed  by  St.  Je- 


CELIBACY.  103 

rome  (contra  Jovinianum  liber}  and  St.  Augustine  (de 
bono  matrimonii),  down  to  the  representatives  of  the  Sal- 
ernitan  school  and  the  Arabian  physicians,  the  claim  was 
raised  during  the  entire  course  of  the  middle  ages,  of 
celibacy  impairing  health.  In  the  era  of  reformation  this 
identical  claim  served  many  a  cleric  who,  in  his  heart, 
had  already  renounced  celibacy,  as  a  pretext  for  shaking 
off  the  cumbersome  fetters.  The  French  encyclopedists, 
of  the  second  half  of  the  eighteenth  century,  poured 
forth  their  jeers  and  sarcasms  against  this  ecclesiastical 
institution,  partly  to  have  it  abolished  on  account  of 
detriment  to  health,  partly  to  be  able  of  transforming 
their  slogan  "  ficrasez  1'infame  "  into  deed  with  chances  of 
success. 

Unbiased  physicians  of  all  ages  never  believed  that 
celibacy  would  impair  health,  a  truism  taught  likewise  by 
daily  experience  in  other  professions.  Of  a  former  period 
may  only  be  mentioned  here  Albrecht  von  Haller  (1708- 
T777)>  a  remarkable  savant  who  ruled  in  philosophic, 
mathematic,  and  historic  domains,  and  who  is,  according 
to  Andrew  Vesalius,  the  founder  of  modern  anatomy  and 
physiology.  "  This  great  man,"  says  Hyrtl,  "  died  with 
his  finger  upon  the  radial  artery,  and  with  the  words,  '  It 
pulses  no  more ! '  Even  his  last  thought  was  physiology." 
Also  Peter  Frank  (1745-1821),  an  eminent  clinic,  de- 
fended celibacy. 

Statistics  also  were  pressed  in  service  against  the  vow. 
They  show  that  married  people  of  both  sexes  live  longer 
than  unmarried. 

According  to  Dr.  Casper,  a  husband  enjoys  the  pros- 
pect of  reaching  the  age  of  sixty  years ;  a  bachelor  must 
rest  content  with  forty-five  years.  Whereas  one-fourth  of 
husbands  attain  an  age  of  seventy  years,  it  is  only  the 
twentieth  part  of  bachelors  that  reaches  that  age.  Among 


io4  PASTORAL   MEDICINE. 

lunatics  and  suicides  two-thirds  to  three- fourths  are  single. 
The  orderly  and  regular  way  of  living,  incidental  to  matri- 
mony, is  taken  to  be  the  explanation  of  the  above  figures. 
However,  there  can  be  no  doubt  that  this  very  cause 
applies,  at  the  least  in  the  same  degree,  to  Catholic  priests 
as  it  does  to  married  men.  The  quoted  statistical  results, 
therefore,  can  not  include  the  clergy. 

Celibates  are  also  the  members  of  both  sexes  of  Cath- 
olic orders,  who  have  devoted  themselves  to  this  voca- 
tion in  obedience  to  the  evangelical  counsels  for  the 
sake  of  self-perfection,  and  to  the  weal  of  their  fellow- 
men.  Of  particular  interest  are  orders  devoted  to  nurs- 
ing the  sick,  inasmuch  as  it  can  be  proven  of  them  by 
figures  that  their  members  are  directly  victims  of  their 
vocation.  A  member  of  those  orders  may  eminently  say 
of  himself,  Aliis  inserviendo  consumer. 

There  are  two  contagious  diseases,  tuberculosis  and 
typhoid  fever,  which  claim  numerous  victims  from  among 
the  members  of  orders  devoted  to  nursing.  In  an  investi- 
gation, by  G.  Cornet,  of  the  mortality  in  orders  that  have 
for  their  object  the  care  of  the  sick,  regard  is  only  paid 
to  Catholic  orders,  both  male  and  female.  The  inquiries 
made  of  religious  communities  for  this  investigation  cover 
a  period  of  twenty-five  years  and  refer  to  cause  of  death, 
age,  the  number  of  years  passed  in  cloister,  duration  of 
sickness,  and  occupation  of  the  deceased;  also  age  and 
number  of  the  yearly  recruitment. 

According  to  reports  from  thirty-eight  cloisters,  aver- 
aging yearly  4028  sisters  and  brothers,  and  an  aggre- 
gate personal  age  of  87,450  years,  the  cases  of  death  in  25 
years  numbered  2099,  whereof  1320,  or  62.88  per  cent — 
nearly  two-thirds — had  been  stricken  with  tuberculosis ; 
whereas,  in  general  only  the  one-seventh  to  one-fifth  part 
of  deaths  are  due  to  tuberculosis.  In  one-half  of  the  com- 


RELIGIOUS   ORDERS.  105 

munities  this  average — two-thirds — was  even  surpassed, 
and  increased  in  some  of  them  to  three-fourths  of  all 
deaths. 

Remarkably  great,  according  to  returns,  is  the  mor- 
tality from  typhoid  fever,  with  8.23,  and  from  cancer, 
with  2.38  per  cent.;  while  death  cases  from  other  sick- 
nesses are  within  the  normal  average.  Most  deaths  oc- 
curred between  the  ages  of  twenty  and  fifty.  Most  of  the 
deceased  brothers  or  sisters  were  from  forty  to  fifty  years 
old. 

With  older  age  mortality  decreases  in  these  orders,  in 
contrast  to  the  fact  that  absolute  mortality  increases  in 
general  up  to  the  seventieth  year.  This  is  explained  by 
the  avalanche-like  rise  of  mortality  in  the  younger  years. 
As  a  consequence,  but  few  reach  a  middle,  to  say  noth- 
ing of  an  older,  age,  and  the  absolute  number  of  those 
who  die  at  an  older  age  must  necessarily  be  small  in  view 
of  the  fact  that  but  few  survive  their  fiftieth  year.  By  add- 
ing to  these  2099  deaths  162  cases  of  death  from  com- 
munities which  reported  only  age,  not  cause  of  death,  we 
arrive  at  an  average  life  of  36.27  years  for  these  2261 
death  cases,  which  proves  an  increased  mortality;  this  is 
the  more  striking  because  those  2261  deceased  were  by  no 
means  in  previous  bad  health ;  on  the  contrary,  they  must 
have  been  strong  and  healthful  when  taking  the  vow.  In 
some  cloisters  the  average  age  amounted  even  to  only  30 
and  28  years,  and  was,  therefore,  lower  than  is  the  case  in 
any  other  profession. 

The  reason  for  this  great  mortality  among  the  mem- 
bers of  orders  devoted  to  nursing  the  sick  is  the  frequency 
of  their  contracting  typhoid  fever  by  way  of  contagion, 
while  following  their  vocation.  This  is  illustrated  by  the 
following  table  of  mortality  in  the  Catholic  orders  de- 
voted to  nursing. 


io6  PASTORAL   MEDICINE. 

DEATHS    WITHIN    TWENTY-FIVE    YEARS 
AT    THE    AGE    OF: 


CAUSES  OP 
DEATH 

?5 

in  a) 

->, 

in" 
1  <* 
*& 

tt 
>no 
«>, 

$z 

?8 

">;» 

*S 

i  CO 

*Z 

*5 

0  4) 
">>> 

fS 

9  v 
«  * 

*s 

D  re 

>£. 
0* 

3 

"o 
H 

Tuberculosis  

14 

164 

348 

525 

2OI 

43 

10 

6 

1320 

Typhoid  Fever... 
Cancer  

5 

41 

54 

2 

47 

12 

19 
15 

10 

!•» 

I 

7 

i 

177 
50 

Among  a  total  num- 
ber of  deaths  of.  . 

23 

243 

472 

711 

347 

ISO 

ICO 

53 

2099 

A  comparison  of  the  general  average  mortality  with  that 
in  orders  caring  for  the  sick  yields  the  further  result  that 
the  relative  mortality  in  such  orders  at  the  ages  from  fif- 
teen to  twenty,  figured  on  an  equal  number  of  living 
persons,  is  four  times  that  of  those  living  in  the  world ;  at 
the  ages  from  twenty  to  thirty,  three  times ;  at  the  ages 
of  thirty  to  forty,  double  that  of  the  others ;  while  from 
the  fortieth  year  up,  the  mortality  in  both  are  about  even. 

In  considering  that  just  such  functions  to  which 
the  greatest  danger  of  contagion  is  attached — cleaning 
of  the  sick  rooms,  making  the  beds,  handling  the  linen 
and  bed  clothes  of  tuberculous,  soiled  with  sputum  and 
discharges — are  chiefly  performed  by  sisters  in  the 
first  years  of  their  duties,  because  growing  age  is  not 
equal  to  the  hard  work,  one  finds  the  explanation  why 
the  number  of  the  infected  decreases  among  sisters  with 
progressing  age,  and  is  most  frequent  during  the  first 
years. 

In  the  orders  included  in  these  statistics  there  died, 
during  twenty-five  years,  sixty-three  out  of  one  hundred 
nurses  of  tuberculosis.  To  the  age  of  fifty  this  disease 
constituted  never  less  than  one-half,  mostly  three- fourths, 
of  the  aggregate  causes  of  death.  Tuberculosis  reaches 


MAN   IN   SICKNESS.  107 

the  climax  at  the  beginning  of  the  third  year  of  hospital 
work. 

According  to  the  findings  by  Cornet,  a  healthy  young 
girl,  devoting  herself  to  nursing  at  the  age  of  seventeen, 
meets  her  death  twenty-one  and  one-half  years  sooner 
than  the  rest  of  the  people  of  the  same  age.  A  nurse  at 
twenty-five,  regarding  the  years  of  life  allotted  to  her, 
stands  on  a  par  with  a  fifty-eight  year  old  person  outside 
of  the  cloister ;  a  nurse  at  thirty-three,  with  one  of  sixty- 
two. 

In  due  consideration  of  all  conditions  entering  in  ques- 
tion, the  sole  and  only  cause  for  the  increased  mortality 
from  tuberculosis  and  typhoid  fever  can  only  and  solely  be 
attributed  to  nursing  the  sick.  The  assumption  that 
cloister  life  in  itself,  especially  on  account  of  celibacy, 
entails  danger  to  health  and  existence  is  entirely  un- 
founded. 

MAN  IN  SICKNESS. 

If  the  well-feeling  of  a  person  is  disturbed,  if  some 
organs  fail  to  function  in  a  proper  way,  and  if  thereto  is 
even  added  a  disorder  in  the  normal  form  or  connection  of 
one  or  more  organs,  then  the  person  is  sick.  Health  and 
sickness  are  relative  and  conventional  perceptions;  they 
are  not  absolute  counterparts.  In  olden  times  men  were 
accustomed  to  regard  sickness  as  something  foreign  to  the 
organism,  something  obtruded,  something  isolated  from 
the  life  of  the  other  parts  of  the  body.  Some  even  went  so 
far  as  to  personify  sickness. 

Many  expressions  used  in  ordinary  life,  as  for  instance, 
"  Sickness  attacks  the  body,"  "  The  body  wrestles  with 
the  disease,"  "  The  physician  fights  sickness,"  "  Nature 
proved  victorious,"  rest  upon  this  philosophical  view  of 
somatic  (corporeal)  processes.  To  fully  perceive  the  error 


io8  PASTORAL   MEDICINE. 

contained  in  this  personification  and  detachment  of  sick- 
ness, we  must  consider  that  the  sick  parts  continue  their 
connection  with  the  rest  of  the  body,  are  fed  by  the  same, 
and  that  circulation  of  the  blood,  the  influence  of  the 
nerves  and  change  of  substance  continue  in  the  sick  just  as 
in  the  healthy  parts  of  the  body.  Diseases  are  nothing 
absolute,  nothing  fixed,  but  processes  wherein  the  single 
appearances  run  their  course  in  the  human  body,  one  after 
the  other,  at  fixed  intervals.  They  are  compound  pro- 
cesses, like,  in  state  of  health,  digestion,  or  nutrition. 
What  we  call  sickness,  is  only  an  abstraction.  In  nature 
there  exist  only  sick  parts,  sick  persons,  but  not  a  tangible 
thing,  sickness. 

The  processes  of  sickness  come  to  pass  chiefly  in  the 
body — somatic  diseases ;  or  they  affect  his  mind — psychic 
diseases.  In  making  this  distinction  between  diseases,  it 
must  be  mentioned  that  in  the  case  of  psychic  disorders 
a  part  of  the  body  is  also  sick — the  brain,  the  organ  of 
spiritual  life. 

I. — SOMATIC  DISEASES. 

Among  the  diseases  of  the  body  we  distinguish  espe- 
cially those  which  start  with  fever  and  those  which  run 
their  course  without  fever.  The  most  striking  symptom  of 
feverish  diseases  is  the  rise  in  the  temperature  of  the  body. 
It  can  be  noticed  from  the  sparkling  eyes  and  the  reddened 
face  of  the  patient.  The  appetite  is  poor,  the  tongue  cov- 
ered with  a  white,  dirty,  or  dark  substance;  the  patient 
calls  for  nothing  but  drink.  By  applying  the  back  of  the 
hand  to  the  skin  of  the  patient,  an  increased  warmth  can 
be  felt.  This  is  a  subjective  way  of  taking  the  heat ;  the  ob- 
jective way  is  by  the  use  of  a  special  thermometer  for  the 
sick.  In  taking  the  temperature  of  persons,  that  part  of 
the  thermometer  containing  the  quicksilver  is  usually 


SOMATIC   DISEASES.  109 

put  under  the  axilla  (arm-pit)  of  the  patient,  who,  to 
hold  it  fast,  must  press  the  arm  against  the  chest.  After 
having  remained  in  this  position  for  a  quarter  of  an  hour, 
the  thermometer  is  taken  up  again  and  read.  A  maximal 
thermometer  continues  to  show  the  indicated  highest  tem- 
perature of  the  patient  even  after  having  been  removed 
from  his  body.  This  kind  of  thermometers  must,  before 
use,  be  slightly  shaken  in  order  to  bring  the  quicksilver 
down  to  its  lowest  level. 

Of  all  feverish  ailments,  the  infectious  diseases  attract 
particular  interest.  All  infectious  diseases  run  their 
course  with  fever,  but  not  all  fevers  are  due  to  infectious 
diseases. 

Among  the  infectious  diseases  are  reckoned  all  those 
forms  of  sickness  caused  by  an  organic  sickness-incit- 
ing germ  (bacillus)  which  has  entered  the  body  of  the 
patient  from  outside  and  propagated  therein.  Diseases 
incited  by  animal  parasites  are  termed  diseases  by  inva- 
sion. They  are  not  counted  among  the  infectious  ones. 
It  follows,  from  the  reproduction  of  the  bacilli  in  the  sick 
human  organism,  that  all  real  contagious  diseases  can  be 
continuously  transferred  from  the  sick  to  the  healthy,  so 
that  the  patient  constitutes  a  direct  transmitter.  The  in- 
fectious diseases  spread  in  this  way  are  called  contagious 
(tuberculosis,  diphtheria).  Is  the  infection  caused  by  the 
surroundings  of  the  patient  which  the  bacilli  infected 
without  his  cooperation,  then  the  disease  is  called  mias- 
matic (malaria). 

Considering  the  manner  in  which  infectious  diseases 
spread,  the  resisting  power  of  their  germs  against  outside 
influences  are  of  the  greatest  significance.  Germs  of 
diseases  of  least  resistance  against  outside  influences  are 
those  of  hydrophobia  and  of  veneric  diseases.  An  uncon- 
scious infection  is  here  impossible,  except  in  the  rarest 


no  PASTORAL   MEDICINE. 

cases;  on  the  contrary,  only  by  a  direct  contact  between 
sick  and  healthy  can  these  diseases  be  transmitted. 

Germs  of  diseases  of  greater  resistance  are  those  of 
acute  exanthema :  Small  pox,  measles,  scarlet  fever,  diph- 
theria, tuberculosis,  typhus,  and  Asiatic  cholera.  These 
germs  can  preserve  themselves  in  the  most  varied  parts 
of  our  surroundings  after  having  left  a  sick  body. 
Hence,  in  order  to  prevent  the  last  named  infectious 
diseases,  it  is  of  utmost  importance  to  know  the  ob- 
jects which  enter  most  frequently  into  consideration  in 
their  quality  as  sources  of  infection,  and  also  the  means 
by  which  germs  are  transferred  from  the  sources  of  in- 
fection to  the  healthy  person. 

(a)  Sources  of  infection.  Sources  of  infection  for  con- 
tagious diseases  are: 

1.  The  discharges  of  the  sick,  like  saliva,  sputum,  pus, 
excrements,  dandruff.    They  constitute  the  sole  sources  of 
infection  in  the  case  of  hydrophobia  and  veneric  diseases. 

2.  Their  linen  soiled  with  discharges,  bandages,  beds, 
and  clothes. 

3.  Eating  and  drinking  vessels.    Objects  named  under 
2  and  3  are  sources  of  infection  in  case  of  acute  exan- 
thema:    diphtheria,    tuberculosis,,    erysipelas,    typhoid, 
cholera. 

4.  The  sick  room  and  its  furniture. 

5.  The  air  in  the  house  may  frequently  contain  the 
inciter  of  acute  exanthema  (measles,  scarlatina,  etc.)  ;  less 
often  that  of  the  abdominal  typhus,  but  never  that  of 
cholera. 

6.  The  water  which  had  been  used  in  washing  or  bath- 
ing the  sick,  in  washing  their  linen,  and  cleaning  the 
sick  room. 

7.  The  contents  of  the  water  closets  as  long  as  they 
are  fresh. 


SOMATIC  DISEASES.  iii 

8.  The  upper  layers  of  the  floor,  which  have  received 
the  sputum  and  ejections  of  the  sick. 

9.  The  convalescent,  as  well  as  the  dead,  body  may, 
under  circumstances,  cause  contagion. 

Means  of  Transmittance. 

The  transmittance  of  germs  from  the  carriers  of  infec- 
tion to  parts  of  the  healthy  body,  from  which  it  can  get 
infected,  takes  place: 

1.  By  contact.     Persons  in  good  health  touch  carriers 
of  infection  either  with  the  surface  of  their  bodies  or 
with    their    mucous    membrane.      Nurses,    physicians, 
clergymen,  the  family  of  the  sick  are  most  exposed.     It 
frequently  happens  that  these  exposed  persons,  while  not 
falling  sick  themselves,  spread  the  disease  by  infecting 
others  in  good  health  by  contact. 

2.  By  eating  and  drinking  substances  containing  germs 
(typhoid,  cholera).    Water  may  be  infectious  even  if  not 
used  as  a  beverage,  but  if  used  to  clean  dishes  and  glasses. 
When  suspicious,  it  should,  therefore,  be  previously  boiled. 

3.  By  inhalation.    The  germs  contained  in  the  dust  of 
the  air  may  by  inhalation  enter  the  nostrils,  the  mouth, 
or  the  lungs,  or  may  be  swallowed  with  the  saliva  (a  fre- 
quent means  of  transmitting  the  bacilli  of  tuberculosis). 

4.  Another  means  of  transmitting  these  germs  of  in- 
fection are  insects.     Stinging  insects  transmit  the  germ 
from  the  patient,  or  from  an  infectious  source,  directly 
into  the  blood  of  the  healthy;  thus,  bedbugs  in  case  of 
recurrent  typhus ;  mosquitoes  in  case  of  malaria ;  and 
flies  in  the  case  of  blood  poisoning. 

Non-stinging  insects  play  also  an  important  part  in 
transmitting  germs,  by  transferring  tiny  parts  of  an  infec- 
tious source  either  to  the  body  of  the  healthy  or  to  his 
food.  These  contagious  objects  are  thus  embodied  in  the 


iia  PASTORAL   MEDICINE. 

organism,  concentrated,  not  diluted  by  air  or  water. 
Hence  flies  should,  as  far  as  possible,  be  kept  out  of  the 
sick  room  of  a  patient  afflicted  with  an  infectious  disease, 
and  care  should  be  taken  lest  such  insects  descend  upon 
his  discharged  matter. 

For  a  long  time  it  has  been  observed  that  of  a  number 
of  healthy  persons  which  had  come  in  the  same  contact 
with  sources  of  contagion,  only  part  of  them  fell  sick; 
others  remained  well,  even  in  continued  danger  of  infec- 
tion. The  former  are  called  predisposed  or  susceptible 
for  some  particular  infectious  disease ;  the  latter  are  called 
immune  or  unsusceptible.  Negroes,  for  instance,  are 
immune  against  yellow  fever  and  are  less  predisposed  for 
malaria  than  the  white  race. 

Little  is  known  as  to  the  conditions  that  cause  the  stated 
immunity  or  predisposition. 

One  kind  of  immunity  is  acquired  by  safely  passing 
through  an  infectious  disease.  Conquering  an  attack  from 
cholera,  as  a  rule — not  always — affords  protection  for 
months  or  years  against  a  repetition  of  the  attack.  A  de- 
cided immunity  for  a  long  period  results  after  one  thor- 
ough contagion  of  the  body  by  pox,  scarlet  fever,  measles, 
spotted  typhus,  and  typhus  of  the  abdomen. 

Basing  on  this  experience,  many  parents  expose  their 
children  intentionally  to  a  thorough  contagion  by  measles 
or  scarlet  fever,  at  a  time  when  the  named  infectious 
diseases  prevail  in  a  mild  form.  By  escaping  from  the 
light  disease  a  protection  is  acquired  against  possible 
graver  forms  of  the  identical  disease. 

Immunity  against  infectious  diseases  is,  furthermore, 
obtained  by  vaccination.  It  affords  protection,  inasmuch 
as  the  body  is  rendered  unsusceptible  against  the  re- 
spective infectious  disease  in  its  grave  form,  by  hav- 
ing been  inoculated  with  a  modified  and  weak  germ  of 


VACCINATION.  113 

the  disease  and  passed  through  the  subsequent  lighter 
form  of  that  disease.  The  widest  known  example  of 
precautionary  inoculation  is  that  by  vaccine  pox.  Vac- 
cine pox  have  their  origin  in  the  transfer  of  genuine 
(human)  pox  to  the  udder  of  cows  (while  milking), 
or  by  vaccination  of  the  animals.  An  English  physician, 
Edward  Jenner,  made  the  discovery,  in  1796,  that  per- 
sons that  had  been  vaccinated  with  the  contents  of 
vaccine  pox  were  unsusceptible  against  contagion  by  the 
genuine  virus.  The  injection  of  the  genuine  virus — a 
process  termed  variolation — was,  at  that  time,  frequently 
used  to  gain  an  immunity  against  pox  in  its  graver 
form,  by  passing  through  the  injected  disease,  which  gen- 
erally was  milder  than  one  caused  by  infection.  Jenner 
showed,  furthermore,  that  vaccine  pox  could  be  trans- 
ferred from  person  to  person,  and  that  this  humanized 
vaccine  matter  afforded  the  same  powerful  protection 
against  genuine  pox  as  the  animal  vaccine  matter. 

The  protective  power  of  inoculation  with  vaccine  mat- 
ter is  certified  to  by  the  result  of  experiments,  by  Jenner 
and  his  contemporaries,  on  several  thousand  persons, 
who  were  subsequently  variolated. 

It  is,  furthermore,  proven  by  exact  statistics  that  dur- 
ing the  century  reckoned  from  that  date,  mortality  from 
pox  has  been  reduced  to  a  minimum  in  countries  where 
vaccination  was  made  obligatory ;  whereas,  in  equally  cul- 
tured countries,  but  without  compulsory  vaccination,  the 
mortality  remained  stationary. 

If  vaccination  is  to  benefit  the  general  state  of  health, 
it  must  be  made  compulsory,  else  many  will  shirk 
vaccination  owing  to  carelessness  or  prejudice.  Com- 
pulsion, however,  seems  only  justified  if  the  dangers  re- 
sulting from  vaccination  are  not  considerable  enough  to 
overbalance  the  gained  immunity  from  smallpox. 


ii4  PASTORAL   MEDICINE. 

Experience  has  shown  that  heretofore  diseased  condi- 
tions have  resulted  from  vaccination  to  some  extent. 

The  small  wound  received  by  the  vaccinated  has  often 
led  to  grave  traumatic  diseases,  especially  to  erysipelas. 
Furthermore,  it  nas  been  found  that  germs  may  be  trans- 
ferred from  one  inoculated  person  to  another  by  vaccina- 
tion. Especially  was  this  observed  in  a  number  of  unfor- 
tunate cases  where  syphilis  had  been  infected  in  this  man- 
ner, owing  to  inattention  in  vaccinating.  That  it  is  pos- 
sible to  transfer  tuberculosis  in  a  like  manner  must  also 
be  admitted. 

Reckoning  with  these  results  of  experience,  only  com- 
petent physicians  should  be  permitted  to  vaccinate,  and 
only  with  the  application  of  antiseptics.  Only  the  lymph 
of  animals  is  permissible.  Animal  lymph  is  now  produced 
in  institutes  belonging  to  the  government,  and  conducted 
with  special  precaution.  After  the  lymph  is  taken  from 
the  calf,  the  animal  is  slaughtered  and  thoroughly  ex- 
amined. The  vaccine  matter  taken  out  is  only  used  if  the 
examination  has  failed  to  disclose  any  traces  of  tuber- 
culosis or  erysipelas.  A  transport  of  syphilis  is  rendered 
impossible  by  animal  lymph. 

A  second  kind  of  inoculation  on  persons,  to  protect 
them  against  infectious  disease,  is  a  process  invented 
by  Pasteur,  of  Paris,  against  hydrophobia.  This  inocula- 
tion is  only  used  on  persons  bitten  by  an  animal  suspected 
of  rabies. 

For  purposes  of  this  inoculation  there  is  used  a  dilu- 
tion of  the  poison  contained  in  the  spinal  marrow  of 
rabbits  stricken  with  rabies.  An  elaborately  and  carefully 
made  preparation  is  made  from  that  marrow,  small  par- 
ticles of  which  are  dissolved  and  administered  by  sub- 
cutaneous injections  to  the  person  in  danger. 

In  the  case  of  an  impending  epidemic,  the  larger  ma- 


EPIDEMICS.  115 

jority  of  the  people  can  not  be  assumed  to  be  immune 
from  the  threatening  disease.  Inasmuch  as  we  know  of 
but  one  preventive  inoculation,  the  vaccination  against 
smallpox,  other  measures  must  be  taken  to  prevent  an 
epidemic  from  spreading. 

The  simplest  preventive  is  to  exclude  the  sources  of  in- 
fection ;  but  in  most  cases  the  task  is  to  keep  those  already 
infected  from  contact  with  people  yet  free  from  infection. 
The  history  of  all  great  epidemics,  from  the  pestilence 
during  the  Peloponnesian  war,  described  by  the  eye- 
witness Thucydides,  and  from  the  plagues  which  devas- 
tated the  Occidental  Empire,  under  Mark  Aurel,  and  the 
Oriental  Empire,  under  Justinian,  down  to  the  black  death 
of  the  Middle  Ages  and  the  cholera  ravages  in  our  days, 
history  teaches  that  contagion  spreads  along  the  tracks 
of  traffic  and  the  highways  of  commerce. 

The  cognizance  of  this  fact  led  to  the  shutting  off  of 
districts  where  epidemics  such  as  pestilence,  cholera,  and 
yellow  fever  prevailed.  This  was  formerly  done  by  mili- 
tary cordons  along  the  border,  and  all  intercourse  with 
persons  and  objects  was  cut  off. 

For  traffic  on  water  similar  measures  of  precaution 
were  taken.  In  the  eleventh  century  the  Venetians,  in 
order  to  prevent  the  plague  from  being  imported,  quar- 
antined every  ship  arriving  from  ports  suspected  of  being 
infected  with  the  epidemic,  for  a  space  of  forty  days 
(quarantina) . 

This  quarantine  is  used  even  to-day  as  a  guard  against 
malignant,  contagious  diseases.  If  the  danger  of  infec- 
tion from  ship  and  her  crew  is  passed,  she  receives  a 
certificate,  with  permission  to  hold  intercourse  or  trade 
with  the  city  or  harbor. 

In  view  of  the  increased  and  fast  traffic  of  to-day  an  ex- 
amination of  the  passengers  has  been  instituted  at  the 


n6  PASTORAL   MEDICINE. 

terminal  stations  along  the  border  and  at  seaports,  in 
order  to  prevent  infection.  Every  person  suspected  of  a 
contagious  disease  is  restrained  from  traveling  further, 
and  is  placed  in  a  hospital  erected  for  that  purpose,  where 
he  is  put  under  surveillance  and  cared  for. 

If,  in  spite  of  all  precaution,  an  epidemic  breaks  out, 
every  infected  should  be  isolated'as  far  as  this  is  possible. 
Isolation  within  the  home  of  the  patient  being  mostly 
inefficient,  his  removal  to  a  well-regulated  hospital  is  by 
far  preferable. 

Germs  of  contagion,  as  reproduced  by  the  sick,  are 
destroyed  by  appropriate  disinfecting.  In  larger  cities 
private  residences,  etc.,  are  disinfected  by  persons  espe- 
cially trained  in  this  important  work. 

Disinfecting  during  a  case  of  contagious  disease  is  done 
as  follows : 

The  discharges  of  the  infected  are  received  in  suitable 
vessels,  partly  filled  with  a  disinfecting  liquid.  Soiled 
linen  and  bedcloth  are  put  in  tubs,  in  the  sick  room,  satu- 
rated with  a  disinfectant  and  kept  there  for  some  hours. 
After  this  they  are  taken  out  for  further  cleansing  .  If  the 
infected  has  left  the  room,  his  bed,  mattress,  and  clothes 
are  enveloped  in  a  sheet,  moistened  with  a  disinfectant 
and  disinfected  by  steam  in  a  disinfecting  apparatus.* 

All  varnished  furniture  in  the  sick  room  is  rubbed  well 
with  a  dry  rag;  other  objects  are  cleaned  with  a  liquid  dis- 
infectant. 

If  the  wall  paper  is  to  be  preserved,  it  is  rubbed  with 
slices  of  newly  baked  bread,  in  the  direction  from  ceiling 
to  floor.  The  crumbs  that  fall  down  are  swept  together 
and  burned.  In  the  same  manner  all  objects  of  little 
value  coming  in  contact  with  the  sick  are  burned  up. 

*  Disinfectors  with  steaming  water  are  to  be  found  in  almost 
any  hospital. 


TUBERCULOSIS.  117 

Lime  water  is  spread  over  the  floor.  After  two  hours 
it  is  removed  by  scrubbing  with  soft  soap,  dissolved  in 
hot  water. 

Thereupon  the  room  to  be  disinfected  is  fumigated  by 
the  burning  of  sulphur  candles ;  it  remains  unoccupied  for 
one  week  and  is  exposed  to  the  air.  After  this  space  of 
time  it  can  be  used  again  without  danger. 

For  liquid  disinfectants  are  used: 

1.  Lime  water.    To  obtain  the  same,  one  quart  of  un- 
adulterated, burnt  lime,  in  small  pieces,  is  mixed  with 
four  quarts  of  water  in  the  following  manner:  About 
three-quarters  of  a  quart  of  water  is  poured  into  a  pail  and 
the  pieces  of  lime  added  thereto.    After  the  lime  becomes 
dissolved,  the  rest  of  the  water  is  poured  in  and  the  mix- 
ture stirred. 

2.  Solution  of  soft  soap.     One  pound  of  soap  is  dis- 
solved in  seventeen  quarts  of  hot  water. 

3.  A  solution  of  carbolic  acid.     The  proper  mixture 
is  held  for  sale  by  all  drug  stores. 

Let  us  illustrate  our  directions  by  applying  them  to  the 
most  important  infectious  diseases. 

Tuberculosis. 

Tuberculosis  (consumption)  is,  in  temperate  zones,  the 
most  widespread  infectious  disease,  amounting  to  fifteen 
per  cent,  of  all  causes  of  death.  The  original  germ  of 
consumption  is  invariably  Koch's  bacillus. 

Sources  of  infection  are,  in  the  first  place,  the  sputum 
of  consumptives,  their  soiled  laundry  and  clothes,  and  the 
air  in  the  room,  infected  by  sputum.  Most  dangerous  for 
the  surroundings  of  the  consumptive  is  his  use  of  hand- 
kerchiefs to  spit  in.  The  sputum  dries  up  easily,  is  rubbed 
into  particles  and  ascends  with  the  cotton  fibrils  of  the 
handkerchief  in  the  air. 


n8  PASTORAL   MEDICINE. 

The  preventive  means  must  begin  with  the  careful  re- 
moval of  the  sputum  of  consumptives.  They  should  only 
depose  their  sputum  in  spittoons  filled  with  water  or  a  so- 
lution of  carbolic  acid.  Handkerchiefs,  or  spittoons  filled 
with  sand  or  ashes,  must  not  be  tolerated. 

Linen  and  clothes  of  deceased  consumptives  are  only 
to  be  used  after  having  been  most  minutely  disinfected 
in  the  steam  apparatus.  The  sick  room  must  be  thor- 
oughly disinfected,  especially  the  bedstead  and  its  con- 
tents. Experience  shows  that  germs  easily  remain  and 
adhere  to  the  bed,  whence  they  mingle  with  the  dust.* 

The  drinking  of  raw  milk  is  not  advisable,  since  it  is 
claimed  that  pulmonary  consumption,  very  frequent  in 
cows,  is  transmitted  by  milk  to  the  human  system. 

Diphtheria. 

This  ravaging  disease  of  children,  up  to  twelve  years,  is 
engendered  by  LoerHer's  bacillus. 

Sources  of  infection  are  the  coughed-up  parts  of  the 
growths  in  the  throat,  the  sputum,  and  the  saliva  of  the 
sick. 

Infection  takes  place  by  directly  coughing  in  the  face  of 

*  A  farmer  had  within  two  years  three  death  cases  from 
consumption  in  his  family.  After  the  last  case  everything  that 
had  come  in  contact  with  the  deceased  was  disinfected  accord- 
ing to  the  above  rules.  I  ordered  the  bed  straw  to  be  burned, 
because  some  of  the  sputum  had  repeatedly  got  into  it.  How- 
ever, the  straw  was  not  burned,  but  removed  to  the  stable  as  a 
litter  for  two  cows.  After  four  or  five  months  one  cow  fell  away 
perceptibly,  and  proved  thoroughly  phthisical  when  killed.  The 
second  cow,  in  good  condition,  was  sold  to  a  butcher.  Upon 
killing,  two  phthisical  knots  were  found  to  be  in  the  lungs.  None 
of  the  other  organs  were  infected.  The  theory  that  the  animals 
were  infected  by  the  bed  straw  of  the  consumptive  suggests  itself. 


CHOLERA.  119 

another  person,  or  by  contact  of  sources  of  contagion 
with  the  mouth  of  a  hitherto  healthy  person;  children, 
for  instance,  are  prone  to  put  all  kinds  of  things  in  their 
mouths  and  thus  easily  catch  the  disease. 

Preventive  measures  consist  in  thoroughly  disinfecting 
the  sputum  and  all  objects  which  diphtheritic  persons 
put  to  their  mouths,  particularly  dishes  and  glasses.  When 
in  danger  of  contagion  by  having  been  coughed  at,  the 
face  must  be  washed  at  once  with  warm  soap  water; 
mouth  and  throat  must  be  rinsed  with  boric  acid  water, 
or,  if  this  is  not  on  hand^  with  a  strong  solution  of  com- 
mon salt  in  boiled  water, 

Cholera  (Asiatic  Cholera). 

The  home  of  cholera  is  the  Delta  of  the  Ganges,  and 
Bengal,  from  whence  it  is  imported  into  Europe  by  land 
or  sea.  The  germ  of  this  murderous  plague  is  the  cholera 
bacillus  discovered  by  Koch  in  1883. 

The  contagious  matter  is  contained  in  the  stool  of  the 
diseased,  and  from  there  may  get  on  or  into  other  persons 
and  into  the  most  various  objects,  and  be  disseminated  by 
them  still  further. 

The  transmission  of  this  bacillus  occurs  through  laun- 
dry, soiled  clothes,  food,  milk,  and  other  beverages,  fruit, 
vegetables,  and  fresh  cheese. 

To  prevent  the  cholera  it  is  mandatory  to  avoid  the 
intercourse  with  persons  and  things  coming  from  places 
where  the  disease  prevails.  In  times  of  cholera  one 
should  get  accustomed  to  regular  habits,  and  take  pains  to 
avoid  indigestion,  as  the  cholera  bacillus  easily  settles 
in  a  sick  intestinal  canal. 

It  is  best  to  boil  the  water  destined  for  drinking  and 
household  purposes,  before  it  is  put  to  use. 


120  PASTORAL   MEDICINE. 

The  stool  of  the  patient,  likewise  his  soiled  linen  and 
bed  clothes,  must  be  disinfected  immediately,  while  yet  in 
the  sick  room. 

Persons  who,  by  reason  of  their  profession,  come  in 
touch  with  cholera  infected,  must,  before  leaving  the  sick 
room,  thoroughly  disinfect  their  hands  with  a  solution  of 
carbolic  soap,  after  previously  having  washed  them  thor- 
oughly with  soft  soap.  Not  until  then  can  they  safely 
take  food  or  touch  their  mouth  again. 

Neither  by  the  air  in  the  sick  room,  nor  by  the  evapora- 
tion of  the  sick,  can  cholera  be  transferred. 

Childbed  (Puerperal)  Fever. 

This  murderous  disease  takes  away  numberless  mothers 
from  their  families  every  year.  It  is  prompted  by  de- 
cayed matter  (cocchi)  coming  in  contact  with  the  genitals 
after  a  recent  parturition. 

These  bacilli  stick  to  the  hands,  cloth,  and  instru- 
ments of  persons  who  render  professional  aid  to  women 
in  labor,  as  midwives  and  physicians.  To  prevent  this 
dangerous  disease,  midwives  must  be  made  to  clean  their 
hands  with  utmost  care  before  lending  help  to  the  lying-in. 
They  must  be  severely  enjoined  not  to  treat  at  the  same 
time  women  in  labor  that  have  fallen  sick  and  others,  re- 
cently delivered.  Beds  occupied  by  women  with  puerperal 
fever  must  be  disinfected  with  utmost  care ;  the  bedstead 
is  to  be  taken  apart  and  washed  with  a  liquid  disinfect- 
ant. 

The  large  space  devoted  here  to  infectious  diseases 
seems  justified  in  view  of  how  important  it  is  to  prevent 
them,  particularly  as  in  many  cases  the  clergyman  is  the 
first  one  able  to  take  measures  against  a  further  spread 
of  a  contagious  disease. 


'APOPLEXY.  121 

It  is  not  our  task  to  furnish  a  pathological  sketch  of  all 
human  diseases.  However,  as  it  must  be  of  interest  to 
the  priest,  in  many  grave  cases,  to  know  the  probable 
course  of  a  disease,  some  of  the  principal  symptoms  may 
be  stated  here,  which  will  enable  even  the  unprofessional 
to  form  a  rough  estimate  of  the  situation. 

The  general  signs  which  indicate  the  approaching  death 
of  the  patient  were  already  described  in  the  chapter  on 
"  Death." 

Let  us  now  review  the  symptoms  of  a  few  diseases 
residing  in  the  three  big  pits  of  the  body. 

Apoplexy. 

A  relatively  frequent  case  of  sickness  with  persons  be- 
yond the  middle  age  is  apoplexy. 

This  sickness  is  caused  by  an  artery  bursting  in  the 
brain,  followed  by  the  effluence  of  the  blood  from  the 
cerebrum.  The  stricken  falls  suddenly  dead  if  the  efflux 
of  the  blood  has  destroyed  vital  cerebral  centres.  If  the 
shock  is  less  violent,  then  consciousness  disappears  partly 
or  entirely,  and  there  appear  signs  of  paralysis  of  one 
portion  of  the  face  or  of  the  limbs  of  one  side.  The 
paralysis  of  limbs  is  on  the  side  opposite  to  that  where  the 
cerebrum  is  injured ;  for  instance,  in  case  of  a  paralyzed 
right  arm  or  right  leg,  then  the  effusion  of  blood  comes 
from  the  left  side  of  the  brain.  Those  stricken  suffer 
in  some  cases  from  a  suspension  of  speech;  the  brain  is 
still  active,  yet  they  are  unable  to  find  the  expressions 
for  their  thoughts. 

Common  belief  assigns  to  the  third  day  after  the  first 
stroke  of  apoplexy  a  particular  tendency  to  bring  a  repeti- 
tion of  the  attack.  This  is  corroborated  by  pathology, 
in  so  far  as  at  that  time  a  reaction  begins  in  the  brain 
by  tHe  surrounding  parts  against  the  suffered  injury, 


122  PASTORAL   MEDICINE. 

which  may  lead  to  inflammation,  more  pressure  of  the 
blood,  and  hence  to  renewed  effusions. 

Resulting  from  an  apoplectic  effusion  of  blood,  or  an 
exudation  from  cerebral  inflammation,  or  an  effusion  of 
blood  caused  by  exterior  violence  directed  against  the 
skull,  a  crowding  of  the  space  within  the  skull  is  effected, 
and  the  brain  is  subjected  to  increased  pressure.  This 
pressure  manifests  itself  outwardly  by  vomiting  or  by  a 
more  or  less  pronounced  stupor,  and  by  a  noticeably 
retarded  pulse.  The  number  of  beats  in  cases  of  grown 
persons  decreases  from  seventy-two  a  minute  to  sixty  or 
fifty  a  minute. 

An  acceleration  of  the  pulsation,  while  the  rest  of  the 
grave  symptoms  continue,  is  a  sign  mali  ominis,  an  indica- 
tion of  the  beginning  of  cerebral  paralysis. 

Diseases  of  the  Respiratory  Organs. 

Affections  of  respiratory  organs,  which  stop  the  inflow 
of  the  indispensable  oxygen  into  the  air-cells  of  the  lungs, 
manifest  themselves  by  the  painful  breathing  of  the 
patient,  whose  countenance  drops,  his  lips  assume  a  bluish 
hue,  while  his  forehead  is  covered  with  cold,  adhesive 
perspiration.  If  the  obstacle  to  free  breathing  (asthma, 
bronchitis,  pneumonia)  is  not  removed  at  an  early  stage, 
then  a  dire  result  is  to  be  apprehended. 

If  pneumonia  takes  a  favorable  turn,  the  dangerous 
conditions,  as  a  rule,  pass  away  within  a  few  hours,  dur- 
ing the  so-called  crisis.  The  patient  falls  into  a  deep 
sleep,  from  which  he  awakes  substantially  improved.  If 
this  common  disease  takes  an  unfavorable  turn,  then  no 
improvement  is  manifest  after  the  elapse  of  a  week ;  the 
fever  continues,  rattling  in  the  throat  begins,  paralysis 
of  the  lungs  sets  in. 


DISORDERS  OF  HEART  AND  ABDOMEN.  123 

Disorders  of  the  Heart. 

The  various  disorders  of  the  heart  are  betrayed  mostly 
by  a  panting  of  the  heart,  short  breath,  even  in  repose,  and 
more  pronounced  when  moving  about ;  sometimes  face  and 
lips  are  of  a  bluish-red  hue;  in  advanced  cases  dropsy 
ensures,  the  pulse  is  low  and  accelerated. 

With  all  serious  heart  trouble  the  danger  of  a  sudden 
death  is  imminent,  particularly  so  with  a  disorder  of  that 
organ  prompted  by  a  calcination  of  its  arteries,  causing 
vehement,  oppressing  spasms  about  the  heart  and  the 
entire  thorax  (angina  pectoris).  This  disease  particularly 
threatens  persons  with  little  exercise.  Yet  workingmen, 
steadily  in  motion,  have  also  suffered  from  a  calcination 
of  the  arteries,  as  proved  by  the  dissecting  table.  Among 
the  working  class,  however,  the  graver  effects,  especially 
sudden  death,  occur  less  frequently. 

Abdominal  Diseases. 

A  serious  disease  of  the  abdominal  pit  is  presented  by 
the  inflammation  of  the  bowels,  an  inflammation  of  the 
membrane  of  the  abdomen  and  the  surface  of  the  viscera. 

The  symptoms  are  severe  pains,  a  disposition  to  vomit, 
and  inflation  of  the  alvine.  Pulsation  is  small,  weak, 
quickened  in  fatal  cases,  hardly  perceptible  to  the  touch. 
The  body  being  inflated  by  gases,  the  diaphragm  can  not 
fall,  the  lungs  in  consequence  can  not  expand,  and  the 
patient  suffers  from  lack  of  breath. 

It  will  be  perceived  from  the  foregoing  that  it  is  quite 
important  for  diagnose  and  prognose  to  observe  the  pulse 
of  the  sick  in  a  competent  manner,  a  mode  of  examination 
particularly  favored  by  physicians  of  old,  while  modern 


124  PASTORAL   MEDICINE. 

disciples  of  Aesculapius  are  only  too  prone  to  look  on  it 
with  contempt. 

Accidents. 

It  is  of  the  greatest  importance  for  the  priest  to  know 
how  to  render  first  aid  to  the  injured.  Not  only  will  this 
knowledge  be  useful  in  accidents  where  he  is  summoned 
to  administer  the  sacraments  to  the  stricken,  but  it  will  be 
almost  indispensable  in  the  school,  where  instances  call- 
ing for  immediate  aid  are  not  infrequent.  We  refer  our 
readers  to  the  Third  Part  of  this  volume,  which  contains 
a  very  complete  chapter  on  FIRST  AID  TO  THE  INJURED. 

II. — MENTAL  DISEASES. 

The  term  mental  disease  is  applied  to  deviations  from 
a  person's  normal  mental  activity.  Their  contrast  to 
somatical  diseases  is  conventional  rather  than  essential, 
for  in  mental  disorders,  too,  there  is  one  part  of  the  body 
ill :  the  brain,  the  organ  of  the  soul. 

This  is  proven  by  the  results  of  autopsy  on  the  corpses 
of  monomaniacs;  it  is  taught  by  a  history  of  the  origin 
of  these  diseases,  and  by  their  symptoms  taken  all  together. 
The  latter  especially  lead  to  the  deduction  that  the 
disease  is  by  no  means  confined  to  disturbances  of  merely 
psychical  functions,  but  that  it  indicates  morbid  changes 
in  the  body  besides  a  deviation  from  mental  normality. 

Historical  Remarks.  The  recognition  of  the  fact  that 
mental  disorder  and  affected  brain  are  synonyms  has 
been  arrived  at  by  observations  of  nature,  by  watching 
the  persons  afflicted  with  sickness.  For  a  long  time  error, 
cruelty,  and  superstition  ruled  supreme  in  the  domain  of 
mental  disorders. 

The  Old  Testament  already  tells  us  of  psychical  mor- 


MENTAL   DISEASES.  125 

bidity.  The  Holy  Scripture  tells  us  of  Saul,  that  the 
spirit  of  the  Lord  had  deserted  him,  that  Saul  was  much 
disturbed  by  an  evil  spirit,  and  that  he  found  relief,  when 
suffering  from  attacks  of  melancholy,  in  David's  playing 
of  the  harp. 

The  book  of  Daniel  narrates  of  Nabuchodonosor,  king 
of  Babylon,  how  he  imagined  himself  to  have  been  trans- 
formed into  a  beast,  how  he  was  turned  out  by  his  people, 
how  he  devoured  grass  like  cattle. 

An  example  of  madness  having  also  been  simulated, 
even  in  ancient  times,  is  offered  by  David's  pretending  to 
be  insane,  thereby  escaping  from  the  apprehended  ire  of 
King  Achis.  Cunning  Ulysses,  too,  simulated  madness, 
lest  he  be  pressed  into  service  for  the  Trojan  war. 

That  insanity  also  took  epidemical  form  is  proven  by 
the  tale  of  the  Scythes,  who,  thinking  themselves  trans- 
formed into  women,  donned  the  garb  and  performed  the 
work  of  women. 

In  conformity  with  the  view  taken  in  early  times  of 
abnormal  conditions  of  mind,  the  diseased  were  either 
worshiped  as  favorites  of  the  gods,  or  they  were  taken  to 
the  temples  of  an  idol  to  be  religiously  influenced  there  by 
priests.  In  Egypt  those  suffering  from  melancholy  were 
sent  to  the  temples  devoted  to  Saturn. 

It  is  only  since  the  advent  of  Hippocrates  that  thera- 
peutics for  lunatics,  as  well  as  for  the  rest  of  human 
diseases,  received  attention.  According  to  the  teachings 
of  Hippocrates,  the  brains  are  the  seat  of  mental  activity, 
and  are,  therefore,  like  the  rest  of  the  organs,  subject  to 
natural  causes  of  diseases.  Mental  disorders  have  their 
origin  in  abnormalities  of  the  brain. 

Actaeus  (60  B.  C.)  and  Galenus  took  the  same  view. 
The  latter  already  distinguished  between  a  primary 
cerebral  disorder  as  causing  the  disease,  and  a  secondary 


i26  PASTORAL   MEDICINE. 

origin  of  the  latter,  due  to  a  morbid  state  of  abdominal 
organs. 

Coelius  Aurelianus,  a  contemporary  of  Trajan  and 
Hadrian,  emphasizes  that  diseases  of  the  mind  are  noth- 
ing else  but  cerebral  disorders  with  prevalent  psychical 
symptoms ;  therefore,  they  belong  in  the  province  of  the 
physician,  and  not  in  that  of  philosophers.  His  method 
to  cure  is  precise,  correct,  free  from  all  coercive  measures. 

After  him  an  utter  decadence  of  this  science  must  be 
recorded.  The  notion  that  the  lunatic  be  possessed  of  the 
devil  was,  for  centuries,  everywhere  in  full  play,  par- 
ticularly since  such  belief  was  supported  by  the  utterings 
of  these  unfortunates.  The  Middle  Ages  have  produced 
hardly  any  other  treatises  on  this  subject  but  on  de- 
moniacs. 

The  numerous  trials  for  witchcraft  furnish  sufficient 
evidence  of  the  treatment  which  real  or  imaginary  lunatics 
had  to  undergo  in  later  centuries,  when  ignorance  and 
superstition  were  rampant.  Such  was  mostly  the  lot  of 
melancholies.  Those  raving  mad  were  kept  fettered  in 
dark  dungeons  until  they  perished  in  filth  and  misery. 

Gentle  lunatics  were  sometimes  granted  refuge  in 
cloisters. 

It  is  known  how  in  Europe  the  mischief  of  trials  for 
witchcraft  was  combated  by  the  Jesuit  von  Spec,  of 
Paderborn  (died  August  7,  1653,  at  Treves),  especially 
by  his  book :  Cautio  criminalis  s.  Liber  de  processu  contra 
sagas. 

Up  to  the  middle  of  the  eighteenth  century  the  lot  that 
fell  to  lunatics  was  very  sad  indeed,  although  sensible 
physicians  had  an  idea  that  the  real  trouble  with  these 
unfortunates  was  a  disordered  action  of  brains  and  nerves. 
The  fact  of  these  disorders  being  curable  by  timely  recog- 
nition and  correct  treatment  was  not  then  known. 


MENTAL   DISORDERS.  127 

The  initiative  in  reforming  and  humanizing  the  treat- 
ment of  the  insane  was  assumed  exclusively  by  the  Eng- 
lish and  French.  Esquirol  was  the  first  French  clinic  to 
lecture  on  psychical  therapeutics.  In  Germany  the  one- 
sided metaphysical  and  psychological  course  taken  there 
by  philosophy  proved  an  obstacle  to  an  improvement  in 
psychiatry.  A  particularly  unfavorable  influence  was  ex- 
ercised in  this  direction  by  the  doctrines  of  Kant  and  the 
natural  philosophy  of  Schelling. 

This  one-sided  conception  of  mental  disorders  was 
shared  by  the  directing  physician  in  the  ward  for  insane 
at  the  Charite  at  Berlin,  Carl  Wilhelm  Ideler  (1795- 
1860),  who,  with  expert  dialectics  and  ample  subtlety,  pro- 
claimed them  to  be  nothing  else  but  morbid  exuberances 
of  passions.  The  reaction  against  this  spiritualistic,  eth- 
ical, and  psychological  course  emanated  from  the  illus- 
trious clinical  authority  Professor  Nasse,  of  Bonn,  a  rep- 
resentative of  the  school  of  natural  science,  who,  in  1818, 
founded  a  periodical  for  psychological  physicians. 

Since  then  the  knowledge  of  mental  disorders  pro- 
gressed also  in  Germany  with  rapid  strides.  Well  man- 
aged institutes  for  the  treatment  and  care  of  the  insane 
were  established  in  all  parts  of  the  country.  The  study 
of  psychological  therapeutics  became  compulsory  in  medi- 
cal faculties. 

Soon  the  existing  institutions  proved  inadequate  for  the 
ever-increasing  number  of  insane  persons.  It  became 
necessary  to  found  special  homes  for  the  care  of  incur- 
ables which  could  not  be  intrusted  to  their  families.  In 
this  way  institutions  devoted  primarily  to  the  treatment 
and  cure  of  insane  patients  were  relieved.  In  our  own 
United  States  the  care  for  the  insane  is  excellent. 

The  increase  of  mental  diseases  within  the  last  decades 
is  unmistakable,  the  growth  of  certain  forms  of  mental 


128  PASTORAL   MEDICINE. 

disorders  simply  frightful.  Special  mention  among  the 
latter  deserve  the  general  paralysis,  or  palsy,  of  the  brains, 
and  the  mental  disorders  originating  from  drunkenness. 
Descendants  from  progenitors  that  had  suffered  from 
psychical  or  nervous  diseases  possess  a  considerable 
disposition  for  mental  disorders.  The  one  burdened  with 
that  inheritance  must  not  necessarily  become  diseased,  but 
he  may  more  easily  become  diseased  than  a  fellow-man  not 
so  inclined  by  heredity. 

The  reasons  which  particularly  favor  an  increase  of  in- 
sanity are  social  conditions  and  the  aggravated  struggle 
for  existence.  These  conditions  begin  with  mental  over- 
work in  youth,  and  remain  a  companion  to  the  craftsman 
or  brain-worker  for  future  years,  in  the  shape  of  priva- 
tions, struggles  and  cares,  sensuality,  dissatisfaction  with 
his  circumstances,  and  other  things,  of  which  our  fathers 
knew  nothing,  or,  at  least,  but  little. 

It  is  the  aggravated  struggle  for  existence  which  enters 
into  consideration,  particularly  in  regard  to  men,  as  one 
of  the  prime  causes  for  one  of  the  most  wretched  forms 
of  mental  disease,  the  paralysis  of  the  brain  or  progressive 
paralysis. 

The  increase  of  insanity  engendered  by  drunkenness  is 
emphasized  by  all  writers  dealing  with  alcoholism  and  its 
effects.  The  vast  importance  of  the  abuse  of  alcoholic 
beverages  in  regard  to  moral,  social,  and  sanitary  condi- 
tions will  have  to  be  dwelt  upon  later  on.  At  present  only 
a  few  expressive  figures  may  be  given. 

Dr.  Gamier,  in  the  January  number  (1890)  of  Annales 
d'Hygiene  Publique,  proves  by  statistics  that  within  the 
last  fifteen  years  the  number  of  insanes  from  alco- 
holism has  doubled.  The  number  of  females  in  Paris 
whose  insanity  was  caused  by  alcohol  has  increased 
seventy-three  per  cent,  within  the  past  fifteen  years.  Ac- 


INHERITED   INSANITY.  129 

cording  to  the  same  observer,  the  cases  of  paralysis  of  the 
brain  have  also  doubled  in  fifteen  years.  The  women,  in 
this  respect  too,  suffer  from  this  disease  to  an  extent 
out  of  all  proportion  with  former  times. 

As  already  stated  before,  an  inherited  disposition  favors 
particularly  the  breaking  out  of  a  mental  disease. 

"  By  far  the  most  important  cause  of  insanity  is  the 
transferability  of  psychopathic  disposition,  and  of  cerebral 
infirmities  in  general,  by  way  of  procreation  "  (Krafft- 
Ebing). 

Next  to  tuberculosis  there  is  hardly  another  domain 
in  the  realm  of  pathology  where  heredity  plays  such  an 
important  part  than  in  that  of  psychical  maladies.  The 
hereditary  burden  is  most  particularly  made  evident  where 
many  intermarriages  between  blood  relatives  have  taken 
place,  for  social  or  religious  reasons. 

In  circles  of  nobility,  in  isolated  groups  of  populace, 
or  in  exclusive,  religious,  communities,  like  Hebrews,  Dis- 
senters, Quakers,  the  percentage  of  heredity  is  larger 
than  in  a  floating  population. 

In  inquiring  after  a  suspected  inherited  disposition  for 
insanity,  one  would  go  wrong  to  merely  take  the  parents 
of  the  patient  in  account.  On  the  contrary,  the  law  of 
Atavism  prevails  here  to  a  large  extent.  The  disposition 
for  sickness  can  be  inherited  by  the  third  generation  from 
the  first  without  the  intermediate  second  evincing  any 
moments  of  infirmity.  The  developed  disease  (innate  in- 
sanity) is  transferred  only  in  rare  cases ;  as  a  rule  only 
the  propitious  soil  is  communicated,  upon  which  psy- 
chosis, favored  perhaps  by  additional  causes,  may  shoot 
up.  Thus  it  happens  that  individual  members  of  an 
onerated  family  escape.  It  is,  therefore,  of  frequent  occur- 
rence to  find  abnormalities  of  a  mental  or  nervous  nature 
in  the  side  relations  (uncle,  aunt)  of  an  insane  person. 


130  PASTORAL   MEDICINE. 

Furthermore,  it  must  be  considered  that  only  in  excep- 
tional cases  the  descendants  are  stricken  with  the  identical 
disease  from  which  the  ascendants  suffered.  On  the  con- 
trary, the  law  of  transmutation  rules  here. 

The  variability  of  inherited  morbidities  sometimes  takes 
the  following  course :  Nervous  diseases,  as  megrim,  hys- 
teria, epilepsy,  prevailed  in  the  ascendancy ;  the  descend- 
ancy  develops  mental  diseases  up  to  idiocy:  the  gravest 
form  of  inherited  degeneration. 

Another  kind  of  transmutation  is  shown  by  the  progeny 
of  pathological  characters,  which  almost  always  are  pre- 
disposed to  insanity.  Certain  fanatics,  cranks,  hypochon- 
driacs, queer  and  eccentric  persons,  not  only  have  quite 
frequently  ascendant  and  collateral  relatives  afflicted 
with  mental  and  nervous  diseases,  but  also  nervous  or  in- 
sane, and  even  idiotic  descendants. 

In  general  it  may  be  said  anent  the  inherited  predis- 
position to  nervous  and  mental  diseases,  that  if  two  hered- 
itarily onerated  individuals  join  in  procreation,  or  if  the 
unpropitious  constitution  of  one  of  the  generators  is  ag- 
gravated by  an  exterior  or  interior  inducement,  then  the 
burden  of  the  progeny  becomes  always  heavier.  Nervous 
diseases  then  develop  into  mental  diseases,  at  first  toler- 
ably harmless,  which,  however,  in  following  generations  or 
in  branch  sides  assume  a  more  and  more  severe  form,  till 
idiocy  finally  ensues.  Then  nature  amortizes  the  patho- 
logical family,  which  loses  the  physiological  faculty  of 
procreation. 

In  this  respect  the  sentence  of  the  Holy  Scripture, 
"  I  shall  avenge  the  sins  of  your  fathers  to  the  third  and 
fourth  generation,"  has  a  most  earnest  significance.  To 
a  large  extent  the  way  of  living,  fortunes  of  life,  and 
selection  of  partners  of  the  ascendants  determine  the  hap- 
piness of  future  generations. 


HALLUCINATIONS.  131 

Next  to  the  organization  of  his  brain,  man  owes  the 
properties  of  his  psychical  being  to  the  kind  and  manner 
of  education  received  in  his  youth.  At  times  infirmities  in 
his  brain  organization  cooperate  with  education  in  calling 
forth  a  disposition  to  mental  morbidities.  It  is  not  only 
by  procreation  that  parents  leave  to  their  descendants  an 
afflicted  organic  constitution.  Psychopathically  predis- 
posed progenitors,  if  affected  with  morbid  passions,  with 
vices,  or  with  eccentricities,  communicate  their  oddities 
and  moral  failings  to  their  children  by  bad  example,  or  by 
giving  them  a  faulty  education. 

Of  corporeal  conditions  predisposing  for  mental  diseases 
particular  stress  is  to  be  laid  upon  the  stages  of  puberty 
and  of  the  climacteric. 

It  may  be  of  importance  to  the  priest  to  know  the  chief 
symptoms  of  psychical  morbidities,  inasmuch  as  he,  in 
general,  is  among  the  first  to  notice  changes  in  this  sphere. 
Hence  let  us  draw  a  brief  outline  of  the  more  important 
mental  morbidities. 

One  of  the  momentous  symptoms  incidental  to  many 
forms  of  mental  disease  must  be  mentioned  right  at  the 
outset :  delusions  in  the  organs  of  sense,  and  such  arising 
from  sensual  perceptions,  which  occur  in  mental  aberra- 
tion :  namely,  hallucinations  and  illusions. 

The  difference  between  the  two  processes  consists 
therein  that  in  hallucination  the  sensual  perception  of  the 
patient  is  not  caused  by  an  extraneous  irritation  of  the 
senses;  whereas  in  illusion  such  an  irritation  on  its  way 
to  the  organ  of  apperception  becomes  perversed. 

Hallucination,  i.  e.,  the  actual  apparition  of  an  image 
of  subjective  origin,  such  as  sounds,  words,  impressions  of 
light,  bad  odors,  abnormal  sensations  of  taste,  is,  there- 
fore, a  sensual  deception,  while  illusion  is  an  error  in  dis- 
cernment of  the  senses. 


13*  PASTORAL   MEDICINE. 

According  to  the  experience  of  specialists,  insanity,  in 
a  majority  of  cases,  manifests  itself  by  the  sensitive  part  of 
the  mind.  There  are  two  distinct  morbid  conditions  of 
this  sensitive  part :  melancholy  and  mania. 

In  MELANCHOLY  the  principal  symptoms  are  a  dole- 
ful mood,  dejection  of  spirits.  It  is  distinguished  from  a 
physiological  depression  by  the  absence  of  any,  or  of  a 
sufficient,  motive.  Hence  neither  the  patient  nor  those 
around  him  can  explain  his  morbid  state. 

Most  apparent  is  the  gloom  at  the  beginning  of  the 
disease.  It  manifests  itself  by  ill-humor,  dejection,  de- 
pression, sorrow.  The  patient  complains  of  oppression, 
a  feeling  of  pain  and  anguish  of  the  heart:  precordial 
anguish.  All  outward  impressions  cause  pain  to  the 
patient,  even  those  that  are  relished  in  normal  state:  in- 
appetency.  Hence  he  has  lost  the  faculty  of  enjoying 
anything;  everything  appears  to  him  colorless,  dismal, 
hopeless,  monotonous;  nothing  interests  him;  in  short, 
all  contrasts  are  wanting  in  his  mind. 

His  imagination,  which  only  gyrates  around  dismal  ob- 
jects, is  likewise  hampered.  The  slow,  labored,  one-sided 
thinking  process  creates  a  feeling  of  stupidity,  a  weak 
memory,  mental  barrenness,  and  gives  rise  to  further 
painful  impressions. 

The  will  power  is  decreased  by  the  gloom,  by  hampered 
imagination,  by  a  feeling  of  a  slight  bodily  fatigue,  and 
by  a  want  of  energy ;  there  is  an  unfounded  lack  of  self- 
confidence. 

Attempting  to  explain  his  morbid  state,  the  patient  then 
often  recurs  to  previous  sins,  perhaps  long  since  atoned 
for.  Self-accusation  follows  and  self-impeachment.  He 
imagines  himself  forsaken  by  God ;  he  can  not  find  mercy 
because  of  his  sin;  he  is  condemned  to  perdition.  Are 
there  corporeal  conditions  (indigestion,  constipation) 


MELANCHOLIA.  133 

which  may  serve  as  an  explanation  for  the  depression, 
then  the  patient  is  full  of  hypochondriac  fancies.  Out  of 
the  feeling  of  incompetency  grows  the  illusion  that  his 
family  must  perish,  that  his  children  will  have  to  starve 
soon. 

Of  course,  quite  an  influence  is  exerted,  in  developing 
melancholy,  by  corporeal  conditions  and  by  the  different 
stages  of  age.  Children  onerated  by  inheritance  or  feeble 
health  fall,  at  the  period  of  puberty,  in  a  melancholy 
mood,  which  is  particularly  in  striking  contrast  to  the 
otherwise  cheerful  disposition  of  their  age.  Suicides  by 
children  find  explanation  in  this  morbid  condition. 

Girls  in  the  stage  of  development,  when  away  from  the 
parental  home,  often  become  homesick,  and,  in  no  rare 
instances,  under  compulsion  of  the  depression,  driven  by 
fancied  dismay  and  coercion,  commit  incendiary. 

The  frequent  melancholic  depression  of  woman  during 
gravidity  or  lactation  is  well  known.  In  aggravated  in- 
stances she  does  violence  to  herself  or  the  infant. 

During  women's  change  of  life,  from  the  forty-sixth 
to  the  fiftieth  year,  the  general  psychical  tuning  down 
of  the  system,  due  to  bodily  mutations,  often  causes  mel- 
ancholy to  develop. 

Persons  afflicted  with  deep  melancholia  are  dangerous 
to  themselves  and  their  fellow  beings ;  they  are  a  public 
danger.  If  the  patient  looks  for  the  reason  of  his 
morbid  condition  within  himself  he  is  apt  to  mutilate 
himself  in  various  cruel  ways,*  or  to  refuse  food 
persistently.  Because  of  the  self-accusations  he  com- 

*  From  my  own  observation  I  know  of  a  melancholic  who,  be- 
cause of  taedium  vitae,  and  as  a  result  of  self-accusations,  cut 
his  feet  with  a  dull  tree-saw  up  to  the  bones,  then  jumped  into 
a  deep  well,  where  he  attempted  to  hang  himself  with  the  sus- 
pended chain. 


134  PASTORAL   MEDICINE. 

mits  deeds  to  impose  just  punishment  upon  himself, 
that  he  may  suffer.  To  escape  from  his  unpropitious 
existence,  to  flee  from  a  base,  sinful  world,  he  commits 
suicide  with  greatest  circumspection,  deceiving  most  cun- 
ningly those  near  him.  He  is  driven  to  murder  his  most 
beloved  family  because  they  might  fall  into  need,  or  be- 
cause he  has  the  best  intention  to  spare  them  a  life  of  cares. 
The  patient  is  still  more  prone  to  commit  such  dire  deeds 
while  enwrapped  in  hallucinations,  hearing  voices  ex- 
horting him  to  act,  reproaching  him,  etc. 

It  is  altogether  incorrect  for  those  around  to  attempt 
to  divert  the  patient,  to  dissuade  him  from  his  fancied 
troubles.  He  only  becomes  still  more  embittered  by  being 
contradicted.  No  one  seems  to  understand  him,  no  one 
knows  the  sorrow  of  his  soul.  Even  the  priest,  who  at  the 
beginning  has  been  molested  by  the  patient  in  his  self- 
accusation,  at  confession,  even  he  has  lost  all  influence 
over  the  melancholic. 

The  melancholic  must  be  removed  as  early  as  possible 
from  his  accustomed  surroundings  and  must  be  placed  in 
an  insane  asylum. 

MANIA  offers  a  picture  of  a  frame  of  mind  opposite 
to  that  of  the  melancholic — an  unwarranted  cheerful- 
ness, an  increased  and  accelerated  run  of  imagination,  a 
heightened  aspiration. 

The  patient  is  more  active,  he  carries  himself  more 
erect,  he  talks  much  and  fast,  he  sings,  whistles,  and  is  in 
the  mood  for  mischievous,  inordinate,  hasty  actions. 
He  produces  striking  thoughts,  acute  epigrams,  witty  re- 
marks and  sarcastic  comments.  A  notion  of  enlarged 
capability  he  manifests  by  praising  his  health,  his 
strength,  his  courage,  his  self-confidence.  His  condi- 
tion, as  a  whole,  is  like  that  of  one  slightly  intoxicated, 
the  more  so,  as  his  taste  for  stimulants  of  all  kinds,  especi- 


MANIA.  135 

ally  for  alcohol,  has  been  whetted,  and  because  alcohol  ex- 
ercises a  more  detrimental  effect  upon  his  morbid  brains 
than  upon  the  brains  of  a  normal  person.  The  maniac's 
humor  turns  often  into  heated  anger  if  he  is  contradicted. 
As  long  as  the  patient  is  master  of  his  temper  he  avoids 
conflicts  with  the  outer  world.  Soon  his  power  of  re- 
straint gets  lost  by  dint  of  his  lessened  resistance  to  liquors. 
By  his  exaggerated  and  easily  hurt  self-esteem,  he  is 
driven  to  rioting,  slander,  insults,  to  disturbing  the  peace, 
causing  damage  and  injury,  and  to  sexual  debauches. 

Raving  madness  is  the  highest  degree  of  maniacal  ex- 
citement. The  mood  is  revealed  by  wild  merriment  or 
irate  frenzy,  by  impetus  for  activity,  by  ceaseless  noise, 
singing,  shouting,  by  destroying  things.  His  thoughts 
are  chasing  one  another ;  they  can  not  be  brought  to  an 
issue,  and  become  hopelessly  entangled.  His  sexual  pro- 
pensity is  increased  and  manifests  itself  in  disgraceful 
acts.  Mania,  when  unmixed,  is  seldom  accompanied  by 
hallucinations. 

It  is  self-evident  to  any  layman  that  patients  of  this  sort 
must  be  put  in  an  asylum. 

MORBIDITY  OF  IMAGINATION.  Physicians  have 
been  of  the  opinion  that  any  disorder  of  the  mind  begins 
with  a  morbidity  of  the  seat  of  affection  and  they  inter- 
preted the  deceptive  visions  as  attempted  declarations  of 
the  changed  mood.  Recent  exact  investigation  and  a  thor- 
ough observation  of  the  patients,  however,  have  led  to  the 
conclusion  that  it  is  the  imagination  that  first  becomes  af- 
fected. This  disorder  of  the  mind  is  called  primary  in- 
sanity, madness  (paranoia). 

The  characteristic  of  the  malady  is  the  developing  of 
fancies  and  visions  without  a  previous  alteration  of  the 
mood.  Cogitation  is  formally  correct ;  it  links  the  fancied 
impressions  together  and  develops  them.  As  the  patient 


136  PASTORAL   MEDICINE. 

can  not  convince  himself  that  he  has  altered,  but  adheres 
to  the  opinion  that  the  outer  world  maintains  toward  him 
a  different  attitude  from  before,  his  false  relation  to  the 
outer  world  changes  consequently  his  standard  as  against 
the  world ;  he  is  insane.  Most  of  such  patients  are  oner- 
ated  by  heredity ;  already  at  an  early  stage  they  have  been 
possessed  of  peculiar  traits  of  character,  eccentric  moods, 
etc.  Any  one  of  the  numerous  casual  causes  effects  the 
breaking  out  of  the  psychical  malady,  of  which,  at  first, 
there  are  only  indications ;  often  the  patient  dissembles  his 
fancies. 

According  to  the  character  of  the  fancies  the  following 
distinctions  are  made : 

(a)  Imagination  of  persecution.  The  patient  imagines 
his  health,  his  property,  his  honor,  etc.,  to  be  threatened. 
Not  perceiving  the  change  in  his  own  mind,  the  patient 
conceives  the  idea  some  injury  to  him  is  being  planned ; 
in  reading  the  newspaper  he  discovers  allusions  to  him- 
self and  his  family,  and  insists  that  some  harmless  re- 
marks are  meant  for  him.  Next  in  order  he  shuns  people, 
is  irritable,  uncommunicative ;  he  complains  of  being  mo- 
lested by  the  police,  by  neighbors,  freemasons,  socialists. 
Delusions  which  appear  in  the  course  of  his  disease  tend 
to  confirm  his  opinion.  For  he  hears  the  jeers  and  threats 
of  his  pursuers,  he  smells  and  tastes  poison  destined 
for  him  in  the  food,  he  feels  magnetic  and  electrical 
operations  on  his  body;  ultimately  he  sees  his  pursuers 
before  his  eyes. 

A  species  of  this  insanity  is  that  of  the  litigious.  It  is 
characterized  by  a  faulty  conception  of  the  law,  the  in- 
ability to  perceive  being  wrong,  unmeasured  positiveness 
and  egotism. 

If  their  case  is  dismissed  or  decided  against  them,  then 
these  persons  imagine  themselves  injured  and  persecuted. 


RELIGIOUS   INSANITY.  137 

They  resort  to  never  ending  demurrers  and  appeals  up  to 
the  highest  court.  The  judges  are  declared  corrupt,  their 
decisions  rendered  in  bad  faith;  all  are  in  conspiracy 
against  them ;  libels  and  contempt  of  court  ensue ;  they  are 
fined  or  imprisoned,  whereupon  new  litigations  arise.  They 
draw  up  numerous  voluminous  documents ;  in  court  they 
deliver  endless  harangues,  excelling  in  repartee  and  in  a 
faithful  memory;  they  study  the  code,  interpreting  the 
laws  according  to  ideas  of  their  own,  become  shysters  and 
champions  of  the  "  oppressed." 

(&)  Religious  Insanity.  In  this  form  of  madness,  like 
the  subsequent  one,  the  imaginations  of  the  morbid 
have  the  character  of  favored  connections.  They  have 
an  exaggerated  notion  about  their  own  importance. 
They  are  mostly  hereditarily  onerated,  and  betray  from 
early  youth  a  "  queer  "  disposition.  However,  non-oner- 
ated  persons  may  also  become  diseased  under  the  impulse 
of  violent,  physically  and  mentally  debilitating  forces,  es- 
pecially after  religious  revivals.  At  the  beginning  of  the 
morbidity  there  appear  hallucinations  in  nearly  every 
sphere  of  sensual  activity.  The  patient  has  the  sensation 
of  a  divine  breath  permeating  his  body;  a  sensation 
of  transfiguration  takes  hold  of  him.  Women  frequently 
reveal  excitement.  Sneers  and  raillery  by  the  surrounders 
are  received  by  the  patient  as  "  trials  "  to  prepare  them 
for  the  vocation  of  a  Redeemer  of  the  world,  of  a  Prophet. 
In,  by  no  means  rare,  cases  they  attempt  to  ply  their  pre- 
sumed call  by  reforming  and  converting,  and  are  quite 
willing  to  use  force  in  their  missionary  attempts.  Arrived 
at  this  stage,  the  patient  must  no  longer  remain  among 
his  usual  surroundings,  from  which  he  should  have  been 
removed  sooner. 

(c)  Insanity  with  erotic  visions.  The  patient  fancies 
himself  loved  by  a  person  in  a  higher  position.  His  love 


138  PASTORAL   MEDICINE. 

to   this   person   is   overflowing,    romantic,   but   platonic 
throughout. 

From  looks  and  deportment  of  that  very  person  the 
patient  gleans  that  he  is  not  indifferent  to  her.  Adver- 
tisements in  the  newspapers,  concerning  other  people,  he 
believes  to  emanate  from  the  beloved  and  to  be  intended 
for  himself.  A  communication  is  soon  established  by 
means  of  frequent  hallucinations  of  hearing  and  vision, 
and  the  intercourse  is  promoted  by  illusions.  Conversations 
by  others  contain  for  him  communications  which  refer  to 
the  presumed  love  affair.  Finally  the  patient  becomes  un- 
bearable by  his  acting  according  to  his  fancy.  He  disturbs 
the  domestic  peace,  assaults  imagined  rivals,  etc. 

(d)  Insanity  with  paralysis  (progressive  paralysis  of 
insane,  dementia  paralytica)  is  a  disease  of  man  at  his 
best  age.     Women  are  not  so  often  attacked  by  this 
disease. 

A  deterioration  of  all  psychical  performances  is  the 
forerunner  of  this  malady.  Forgetfulness,  absentminded- 
ness,  laziness,  irritability,  lack  of  will  power,  are  notice- 
able. The  altered  character  is  evinced  in  tastes  foreign  to 
his  former  views.  He  exhibits  a  desire  for  drink,  is  inclined 
to  be  extravagant  and  to  indulge  in  sexual  debauches. 
Soon  corporeal  symptoms  are  added,  the  patients  walk  un- 
steadily, they  write  a  different  hand,  they  are  of  slow 
speech,  their  tongue  falters,  the  expression  of  the  face 
changes  on  account  of  a  paralysis  of  the  moving  nerves. 
Blood  rushes  to  the  head,  followed  eventually  by  apo- 
plectic attacks,  which  at  first,  however,  quickly  disappear, 
without  leaving  paralysis  of  the  limbs.  Soon  arises  in  the 
psychical  sphere  one  of  the  most  marked  symptoms  of  this 
disease : 

(e)  The  delusion   of  illustriousness.     The   delirious 
notion  of  grandeur  by  paralytics  differs  from  a  similar 


PARALYSIS.  139 

fancy  by  maniacs  therein  that  in  a  paralytic  brain  all 
spheres  of  possibility  are  by  far  transgressed,  all  bounds  of 
time  and  space  overleaped.  The  patient  is  God,  higher  than 
God ;  he  has  millions,  owns  castles  of  diamonds ;  he  is,  all 
at  once,  Napoleon,  Julius  Caesar,  Washington.  No  rea- 
sons are  advanced  for  his  fancies.  They  are  not  connected, 
because  of  the  impending  psychical  infirmity.  What 
the  imagined  greatness  consists  of,  depends  entirely 
upon  the  education  and  social  position  of  the  diseased. 
Finally  the  patient  becomes  more  and  more  idiotic,  be- 
cause of  progressing  disease  of  the  brain.  He  either  suc- 
cumbs to  a  stroke  of  apoplexy,  or  dies  of  aseptic  blood 
poisoning,  which  often  sets  in  if  the  skin  has  been  made 
sore  by  lying. 

Having  been  made  acquainted  with  some  morbidities  of 
mental  life  in  the  sphere  of  feeling  and  thinking,  let  us 
glance  at  the  disorders  of  the  will  and  of  the  propensities. 

Physiological  life  knows  but  an  impulse  of  self-preser- 
vation and  a  sexual  impulse.  Morbid  life  does  not  create 
new  impulses,  as  formerly  falsely  assumed.  The  doctrine 
of  morbid  impulses  culled  by  psychiatry  from  French 
works  defied  all  laws  of  morality  and  of  society.  If  a 
person  under  somewhat  striking  circumstances  committed 
a  crime  against  life  or  property  of  his  fellow-beings,  then, 
according  to  that  doctrine  of  monomania,  he  was  not  to 
be  impeached  for  the  deed ;  he  was  suffering  from  a  mor- 
bid impetus  to  a  criminal  act,  for  which  ne  could  not  find 
any  restraint  in  his  powers.  The  following  morbid  im- 
petuses were  fixed:  To  steal,  kleptomania;  to  lust,  aidoio- 
mania;  to  suicide,  monomaniacal  suicide;  to  murder, 
monomaniacal  homicide. 

A  morbidity  in  psychical  life  can  only  decrease,  increase, 
or  pervert  already  existing  natural  impulses. 

Anomalies  of  the  appetite.    An  increase  of  this  impulse 


1 40  PASTORAL   MEDICINE. 

can  be  caused  by  bulimia,  a  voracious  appetite,  which  ap- 
pears shortly  after  meals  and  alternates  with  inappetency. 
This  morbidity  is  found  in  hysterics  and  maniacs.  It  is 
different  from  the  want  of  feeling  of  satiety  common  with 
idiots,  which  leads  to  overloading  the  stomach. 

A  decrease  of  appetite  is  found  with  melancholies, 
hypochondriacs,  hysterics.  Maniacs  often  refuse  to  take 
food,  because  of  some  fancy,  for  instance,  not  being  worthy 
to  partake  of  food,  because  they  are  sinners,  or  because 
they  can  not  pay  for  it,  have  no  longer  a  body,  because 
stomach  and  guts  are  constipated,  because  they  are  dead, 
or  have  putrefied  intestines.  Or  they  suffer  from  hallucina- 
tions. Voices  command  them  to  fast,  or  the  food  tastes 
like  poison,  like  having  been  polluted. 

The  perversions  of  appetite  occur,  as  it  is  known,  also 
in  some  corporeal  morbidities,  where  the  psychical  life 
remains  intact.  So  the  desire  of  anaemic  girls  to  stealth- 
ily eat  lime,  salt,  sand ;  the  preference  of  the  hysterical  for 
offensively  smelling  and  tasting  substances,  like  valerian, 
asafetida;  the  hankering  of  pregnant  women  after  most 
peculiar  things  to  eat ;  and  other  aberrations  of  taste.  A 
revolting  perversion  of  this  propensity  in  grave  psychical 
disorders  is  the  coprophagy,  the  impulse  to  eat  their  own 
excrements. 

Anent  the  anomalies  of  the  sexual  impulse  it  suffice  here 
to  remark  that  with  neuropathic,  hereditarily  predisposed 
persons  the  sexual  impulse  manifests  itself  at  an  abnor- 
mally early  age,  leading  to  sexual  excesses.  More  im- 
portant for  the  priest,  as  teacher  of  morals  and  as  psy- 
chologist, are  the  perversions  of  the  sexual  impulse,  since 
he  must  there  distinguish  between  morbidity  and  moral 
depravity. 

Any  act  of  sexual  gratification  contrary  to  the  inten- 
tion of  nature,  to  propagation,  must  be  declared  perverse. 


EPILEPSY.  141 

It  is  to  be  noted  that  not  every  perverse  sexual  act  is  a 
morbid  one.  From  the  pool  of  moral  depravity  spring 
the  sexual  aberration  of  profligates,  widely  spread  in  the 
days  of  the  ancient  Greeks  and  Romans,  and  to  be  met 
with  even  in  our  days.  For  obvious  reasons  this  is  not  the 
place  to  further  discuss  this  particular  chapter. 

The  free  exercise  of  the  will  is  interfered  with  by  any 
form  of  mental  disorder.  Christian  morality  and  the 
criminal  codes  of  all  civilized  nations  acknowledge  this 
fact. 

Free  exercise  of  the  will  in  one  insane  is  impossible : 

1.  Because  in  consequence  of  the  morbid  alteration  of 
the  brain,  the  organ  of  the  soul,  there  arise  impulses  to 
deeds  which  fail  to  be  restrained  by  moral  and  ethical 
countermotives,  lacking  by  reason  of  that  very  morbidity. 

2.  Because  the  consciousness  of  the  ego  and  the  per- 
ception of  the  outer  world  have  been  displaced  by  decep- 
tive fancies  and  hallucinations     Although  the  punishable 
deed  has  been  committed  by  that  very  person  under  juris- 
diction,   he    was    psychologically    an    entirely    different 
being, 

Nervous  Disorders. 

Let  us  now  turn  to  two  nervous  diseases,  which  as  such 
can  exist  by  themselves,  but  which  also  frequently  cause 
a  psychical  disorder  to  root  on  their  soil  and  which  are  en- 
countered many  times  by  the  priest  in  everyday  life.  They 
are  epilepsy  and  hysteria. 

EPILEPSY.  Epilepsy  is  a  chronic  disease  which  in  its 
developed  form  consists  in  frequent  attacks  from  general 
spasms,  with  complete  suspension  of  sensation  and  of  con- 
sciousness, and  lasting  from  a  few  seconds  to  some 

minutes. 
These  spasms  are,  in  many  instances,  preceded  by  warn- 


142  PASTORAL   MEDICINE. 

ings.  The  patients  feel  a  pricking  or  a  twinge  in  leg  or 
arm,  or  a  pressure  rising  to  their  head.  The  epileptic, 
sometimes  with  a  piercing  cry,  falls  to  the  ground,  losing 
sensation  and  consciousness. 

During  the  first  moments  after  the  fall  the  patient's 
muscles  are  rigidly  contracted.  The  breath  is  drawn  in, 
the  eyes  are  wide  open,  arms  and  legs  stretched  and 
straight.  After  a  few  minutes  this  rigidity  ceases,  and 
is  superseded  by  violent  convulsions  of  all  muscles. 
Respiration  is  blocked  by  the  cramp  of  the  thoracic 
muscles  employed  in  breathing.  Hence  the  face  assumes 
a  bluish  hue,  becomes  swollen.  The  agitation  of  the 
lingual  muscles  forces  the  saliva  out,  which  escapes 
in  bubbles.  Frequently  it  is  mixed  with  blood,  the  epi- 
leptic having  bitten  his  tongue. 

During  the  fit  it  is  necessary  to  guard  the  patients 
against  injuring  themselves ;  especially  must  their  faces 
be  kept  from  falling  into  liquids,  as  they  may  thus  be 
easily  asphyxiated. 

In  case  of  attacks  recurring  for  years,  there  develops 
a  certain  grade  of  dullness,  which  in  grave  cases  may  de- 
generate into  idiocy.  In  most  patients  the  so-called  epi- 
leptic alteration  of  character  can  be  noticed  in  the  inter- 
vals between  fits.  It  is  an  abnormal  irascibility,  a 
peevish  mood,  which  fluctuates  with  increased  capricious- 
ness  between  psychical  depression  and  exaltation.  To 
this  undulating  mood  corresponds  a  pathological  religious- 
ness. They  are  religiously  either  exalted  without  any 
reason,  or  abnormally  contrite.  Many  epileptics  evince  a 
tendency  to  sanctimony  and  asceticism,  which  offers  a 
striking  contrast  to  their  usual  fretfulness  and  incom- 
patibility. These  traits  are  especially  noticeable  in  asy- 
lums. It  is  only  in  rare  cases  that  the  mental  faculties  are 
left  entirely  intact  by  epilepsy. 


EPILEPSY.  143 

The  classical  attacks,  indicated  by  general  spasms,  may 
be  substituted  in  epilepsy  by  equivalent  nervous  attacks 
which  at  first  sight  have  nothing  in  common  with  the 
falling  sickness.  Such  psychical  equivalents  are: 

1.  Conditions  of  unconsciousness,  lasting  frequently  for 
a  few  seconds  only.    The  patient  suddenly  interrupts  his 
speech;  if  walking,  he  stops;  he  drops  anything  held 
previously  in  his  hand.     If  this  morbid  attack  continues 
for  some  time,  the  patient  commits  acts  in  violation  of 
common  sense,  of  morals,  and  of  laws.     Such  mental 
absence  either  follows  epileptic  fits,  or  initiates  them,  or 
the  whole  attack  consists  merely  of  a  short  suspension  of 
consciousness. 

2.  Greater  disturbances  of  consciousness,  accompanied 
by  awful  visions  (blood,  fire,  etc.)  ;  these  follow  at  times 
grave  attacks  (postepilectic  madness),  and  end  in  sleep, 
with  a  subsequent  recovery  of  consciousness  without  any 
recollection  of  what  has  happened. 

While  in  that  delirious  state  the  epileptics  are  likely  to 
commit  the  most  violent  assaults  upon  other  persons. 

3.  Epileptic  vertigo.     The  invasion  is  by  light  con- 
vulsions.    The  head  is  swimming,  objects  appear  sud- 
denly to  circle  about  the  patient,  consciousness  is  only  sus- 
pended  for  the  briefest  time,   hardly  noticeable.     The 
patient  himself  declares  after  a  few  seconds,  "  It's  over." 

It  is  self-evident  that  the  deplorable  epileptics  are  not 
only  ill  at  the  time  when  visited  from  an  attack 
of  their  grave  malady,  but  that  there  prevails  an  endur- 
ing morbid  condition  of  the  brain,  the  attack  or  its 
equivalents  representing  merely  a  temporary  discharge. 
On  account  of  the  continuous  morbidity,  the  removal  of 
these  patients  into  an  asylum  is  opportune  if  they  fail  to  be 
attended  at  home  with  expert  care.  Many  patients,  whose 
condition  at  home  is  pitiable,  improve  when  cared  for  in 


144  PASTORAL   MEDICINE. 

an  asylum.  The  attacks  can  be  made  milder,  the  incidental 
danger  for  the  patient  is  minimized  by  the  watchfulness 
of  the  nurses.  His  spirits  are  revived.  His  depression 
gives  room  to  confidence  if  he  perceives  how  he  can  find 
an  occupation  and  be  useful  notwithstanding  his  sickness  ; 
whereas  this  was  impossible  for  him  while  at  home. 

HYSTERIA.  This  term  applies  to  a  nervous  disease 
marked  by  an  abnormal  irritability  in  those  nervous 
spheres  which  bring  about  sensation  and  motion,  but 
which  also  and  particularly  appears  in  the  psychical  do- 
main, when  no  evidence  can  be  found  of  anatomical 
changes  in  the  central  organ  of  the  nervous  system,  brain 
and  spinal  marrow. 

The  word  hysteria  indicates  the  assumption  in  former 
times  that  the  disease  was  confined  to  the  female  sex  and 
that  it  initiated  from  the  sexual  organs.  Both  assumptions 
are  erroneous.  Neurotic  hysteria  is  also  a  disease  of  men, 
although,  by  far,  more  seldom  than  of  women. 

The  fact  that  hysteria  is  frequent  in  women  who  suffer 
of  a  disease  of  the  sexual  organs  only  indicates  that  this  is 
one  of  the  ways  in  which  like  disturbances  of  the  nervous 
system  may  arise. 

The  abnormally  increased  irritability  of  the  sexual 
nerves  is  characterized  by  various  sensations  of  pain. 
Their  peculiarities  are  a  steady  change  in  the  seat,  extent 
and  duration  of  the  pain,  want  of  a  traceable  original 
cause,  a  sudden  disappearance  of  pain  or  its  leap  to  other 
nervous  spheres  previously  unaffected. 

In  place  of  an  oversensitiveness,  an  insensibility  of 
single  corporeal  regions  has  been  observed  in  grave  cases. 
Of  perverse  sensations  peculiar  to  hysteria  may  be  men- 
tioned clavis  hystericus:  the  sensation  of  a  nail  piercing 
the  brain ;  globus  hystericus:  the  sensation  of  a  ball  tak- 
ing its  course  from  the  heart  to  the  larynx  and  causing 


HYSTERIA.  145 

oppression.  The  nerves  of  the  organs  of  senses  are  like- 
wise at  times  in  an  oversensitive  condition.  The  eye  is 
painfully  affected  by  the  ordinary  irritation  of  the  sun- 
light. Noises  which  never  molest  a  normal  ear  are  un- 
bearable to  hystericals.  Odors,  not  disagreeable  to  others, 
greatly  annoy  these  patients,  whereas  smells  which  are 
not  pleasing  to  most  persons,  for  instance,  the  odor  from 
burning  feathers,  of  the  valerian  weed,  etc.,  agree  with 
them. 

In  the  nervous  realm  of  motions  convulsions  and 
cramps  take  place  in  hysterical  persons.  Even  complete 
spasmodic  attacks,  as  in  epilepsy,  may  occur,  preceded  at 
times  by  shrieking,  howling,  barking,  laughing,  or  crying. 
During  these  spasms  consciousness  is  mostly  not  alto- 
gether suspended.  After  the  attack  has  run  its  course 
the  patients  soon  recover  entirely  without  being  the 
worse.  These  attacks  occur  only  when  the  hysterical  is 
awake,  in  daytime,  never  at  night,  in  contrast  to  epilepsia 
nocturna.  Just  as  oversensitiveness  in  some  cases  is  re- 
placed by  insensibility,  so  we  meet  here,  besides  a  height- 
ened irritability  expressed  by  convulsions  and  by  cramps, 
with  a  paralysis  of  single  groups  of  muscles.  Even  the 
whole  body  is  sometimes  in  a  state  approaching  paralysis, 
which  prompts  many  hystericals  to  remain  in  bed  for 
months  and  to  scrupulously  avoid  any  exercise. 

Of  greater  import  than  the  physical  condition  of  hys- 
terics is  to  the  clergyman  their  psychical  mood.  Hys- 
terical people  are  not  only  a  crux  medicorum,  but  are  tor- 
mentors of  the  priest,  in  and  out  of  the  confessional. 

Affections  are  called  forth  with  ease.  The  patients  are 
easily  frightened,  easily  overwhelmed  by  everything  un- 
expected, sensitive  to  pain  and  easily  offended.  Any 
trifle  puts  them  out  of  humor  and  causes  excitement, 
never  ending  until  some  new  irritation  occurs,  which  is 


146  PASTORAL   MEDICINE. 

apt  to  call  forth  the  opposite  mood,  and  just  as  strong  as 
the  previous  one. 

The  dismal  mood,  during  which  the  patients  are  an- 
noyed and  pained  by  everything,  and  feel  unhappy  and 
incompetent  for  anything,  may  be  followed  immediately 
by  a  most  cheerful,  often  also  playful  and  mischievous 
humor,  wherein  they  see  everything  in  a  roseate  hue  and 
are  often  capable  of  performing  astonishing  feats.  The 
whimsical  temper  is  the  proverbial  trait  of  hystericals. 
It  manifests  itself  in  a  perpetual  attempting  and  abandon- 
ing, in  spasmodic,  hasty  actions  without  enduring  energy. 

At  the  same  time  the  patient  endeavors  to  impress  her 
people  with  the  idea  that  her  condition  be  something 
utterly  pitiable,  grand  and  extraordinary,  her  heated 
imagination  often  violating  the  truth.  The  border  line  be- 
tween this  abnormal  psychical  conduct  and  a  genuine 
mental  disease  can  hardly  be  drawn.  The  degree  of 
psychical  change  is  less  decisive  in  this  respect  than  the 
duration  of  the  morbid  psychical  symptoms.  Only  after 
enduring  alterations  of  the  imaginative  activity  have  de- 
veloped, accompanied  by  hallucinations,  only  then  is  it  a 
case  of  hysterical  mental  disorder. 

The  objects  of  the  fancies  by  morbid  hysterical  changes 
according  to  the  intelligence  of  the  patient.  Frequently 
the  object  is  a  religious  one — the  patients  see  the  gates 
of  heaven  opened,  have  divine  apparitions,  have  inter- 
course with  saints,  they  hear  and  proclaim  all  sorts  of 
prophecies,  with  or  without  sense. 

The  attacks  of  demonism,  which  have  played  a  promi- 
nent part  particularly  in  the  hysterical  epidemics  of 
former  centuries,  and  which  yet  occur  even  to-day,  have 
their  roots  likewise  in  religious  fancies.  The  patients 
believe  to  house  the  devil,  or  various  evil  spirits, 
within  their  body,  to  be  driven  by  them  to  contortion  and 


HYSTERIA.  147 

paroxysm,  and  to  be  compelled  to  utter  unholy,  shame- 
ful remarks,  speaking  for  the  unclean  spirits  and  against 
their  own  volition.  Many  vary  even  the  pitch  of  voice, 
according  to  whether  one  or  the  other  evil  spirit  com- 
pels them  to  speak.  An  erotic  trait  is  seldom  missed  in 
those  cases.  It  is  most  undisguised  in  cases  where  de- 
lirious patients  imagine  to  have  been  abused  by  persons 
about  them.  The  details  are  often  told  with  such  vivid- 
ness, and  deviate  so  little  from  the  possible,  that  at  various 
times  such  charges  have  led  to  trials,  and,  in  some  in- 
stances, to  convictions. 

In  touching  upon  a  few  prime  causes  of  hysteria,  we 
meet,  like  in  all  nervous  morbidities  in  a  wider  sense, 
as  most  important  cause  the  hereditary  oneration.  Par- 
ticularly occurs  here  immediate  communication  in  this 
manner.  Hysteria  of  parents,  or  ancestors  in  general,  re- 
sults in  hysteria  of  the  children.  Especially  the  communi- 
cation of  this  sickness  from  the  mother  to  the  daughter 
occurs  extraordinarily  often. 

The  most  essential  influence  upon  both,  the  suppression 
and  the  development  of  hysterical  predisposition,  is 
exercised  by  education. 

It  is  possible  by  a  fitting  influence  upon  body  and 
mind  to  smother  the  existing  predisposition  to  hysteria; 
but  also,  vice  versa,  a  non-existing  predisposition,  or  one 
in  a  slight  degree,  may  be  developed  artificially.  All  in- 
fluences favoring  corporeal  feebleness  operate  in  the  lat- 
ter respect ;  therefore,  a  too  effeminate  education,  whereby 
the  body  does  not  obtain  the  necessary  degree  of  resist- 
ance, is  just  as  detrimental  as  one  too  strenuous,  which 
exacts  efforts  beyond  capability.  Both  extremes  are  also 
detrimental  in  moral  respects. 

By  too  much  yielding  a  lack  of  will  and  a  capricious- 
ness  are  favored,  which  furnish  auspicious  conditions  for 


148  PASTORAL   MEDICINE. 

the  appearance  of  hysteria.  Too  much  severity  and  in- 
timidation are  apt  to  call  forth  so  violent  an  agitation  that 
it  causes  increased  irritability  of  the  entire  nervous  sys- 
tem, paired  with  weakness  of  character,  a  result  which 
promotes  the  disease.  The  greatest  danger,  however,  lies 
in  an  unsteady,  whimsical  education,  wherein  immoder- 
ately now  one,  now  the  other  course  is  pursued. 

Particularly  dangerous  are  excessive  demands  from 
the  mental  capability,  the  overburdening  with  objects  of 
instruction  and  inciting  ambition  at  the  same  time.  Want 
of  sufficient  exercise  is,  as  a  rule,  another  inciter. 

The  influence  of  a  faulty  education  on  the  develop- 
ment of  hysteria  can  not  be  appreciated  thoroughly  with- 
out taking  account  of  a  cooperating  lesser  circumstance, 
which  is  found,  even  at  a  higher  age,  to  be  one  of  the 
causes  of  hysteria — the  stimulation  of  the  impulse  of 
imitation.  Hysterical  mothers  not  only  communicate  the 
germ  of  the  disease  to  their  children,  they  also  favor  its 
development  by  the  education  they  give  and  by  their 
example.  First  of  all  the  symptoms  of  these  attacks, 
especially  paroxysm,  incite  imitation.*  But  even  the 
entire  way  of  feeling  and  of  thinking  is  communicated 
with  continued  intercourse.  This  so-called  imitative  in- 
fection is  found  to  operate  at  times  on  nurses,  having 
attended  hysterical  patients  for  a  long  time,  in  a  similar 
way  as  it  does  upon  children.  Also  other  patients,  having 
been  in  the  same  room  with  hystericals,  or  casual  wit- 
nesses of  hysterical  paroxysms,  become  frequently  in- 
fected. 

*  Professor  Hirt,  of  Breslau,  reports  that  in  a  village  school 
of  Silesia  there  were  twenty  girls  out  of  a  total  of  thirty-eight 
who  became  ill  with  hysterical  spasms.  Professor  Hirt  positively 
declares  that  the  spreading  of  the  morbidity  among  these  chil- 
dren was  caused  by  the  impulse  to  imitate. 


DISEASES  DUE  TO  OCCUPATIONS.       149 

This  imitative  infection  has  no  small  bearing  upon 
the  spread  of  hysteria  in  public  and  boarding  schools. 
It  has  been  a  matter  of  observation  that,  after  the  first 
case  of  spasms  in  the  presence  of  other  pupils,  there  soon 
ensued  several  similar  cases  in  girls  previously  healthy. 


III. — DISEASES    DUE   TO    CERTAIN   OCCUPATIONS. 

SAFETY    DEVICES    FOR    WORKINGMEN. 

SOCIAL    LEGISLATION 


A  group  of  diseases  is  caused  by  the  nature  of  a  man's 
calling,  the  daily  occupation,  as  is  particularly  the  case  with 
workingmen.  In  the  majority  of  cases  the  disease  is 
caused  by  the  material  handled,  for  instance,  mercury  in 
plate  glass  factories,  phosphorus  in  match  factories,  lead 
in  making  lead  paints,  etc. 

But  also  non-poisonous  materials  are  apt  to  cause 
diseases  if  they  pulverize  too  much  in  the  course  of 
their  handling.  The  dust  particles  of  the  working  ma- 
terial are  absorbed  by  the  lungs  and  incite  certain  morbid 
changes  of  that  organ,  which  are  termed  dust  inhalations. 

Not  only  dust  particles  of  the  working  material  are 
inhaled,  also  different  gases  which  develop  in  many  in- 
dustrial processes.  Diseases  from  gas  inhalation  form  an- 
other class  of  such  diseases.  Furthermore,  many  diseases 
of  workingmen  are  caused  by  physical  overexertion,  be 
it  that  the  work  itself  taxes  the  muscles  too  much,  be 
it  that  the  body  is  not  developed  sufficiently,  or  strong 
enough,  to  perform  a  certain  work  (children  and  women). 
In  some  trades  certain  organs  of  the  body  or  certain 


i5o  PASTORAL   MEDICINE. 

groups  of  muscles  must  be  particularly  exerted,  and, 
therefore,  are  more  exposed  to  injury.  A  fixed  attitude 
of  the  body  long  maintained  during  work  leads  finally 
likewise  to  disease. 

I  assume  that  this  class  of  diseases  is  of  interest 
to  the  priest  because  his  vocation  brings  him  quite  often 
in  touch  with  the  industrial  workman.  This  intercourse 
seems  to  make  it  desirable  for  the  clergyman  to  obtain 
a  general  outline  of  the  dangers  threatening  the  health 
of  his  parishioners. 

It  is  self-evident  that  the  handling  of  poisonous  ma- 
terials in  the  course  of  his  work  must  entail  grave  dangers 
for  the  workingman's  health.  The  doors  by  which  these 
poisonous  substances  enter  the  system  are  lungs,  stomach, 
and  skin  of  the  workingman. 

The  handling  of  mercury  entails  many  dangers  to  health, 
both  at  the  place  where  it  is  produced :  at  the  quicksilver 
mines,  and  in  the  different  manufactories  where  it  is  used, 
in  silvering  mirrors,  in  hat  factories,  etc.  Ulcers  in  mouth 
and  throat,  convulsions,  and  finally  general  cachexy  ap- 
pear if  the  workingman  relaxes  in  his  caution.  Therefore, 
the  workingman  must  be  in  perfect  health  before  starting 
work,  and  must  be  constantly  on  his  guard  during  work. 

Preventive  measures  are  embodied  in  detail  in  factory 
rules.  They  relate  to  the  workshop  and  the  clothes  of  the 
men  at  work.  In  rooms  where  mirrors  are  silvered,  special 
clothes  must  be  worn.  Every  workingman  must  wash 
himself  carefully  before  and  after  work  and  rinse  his 
mouth  with  a  prescribed  solution.  Meals  must  be  taken 
in  a  different  room.  A  workingman  must  not  be  em- 
ployed in  the  dangerous  silvering  room  longer  than  four 
hours  a  day  and  not  oftener  than  three  times  a  week. 

The  trade  wherein  chiefly  the  poisonous  phosphorus  is 
used  are  the  match  factories.  The  handling  of  phos- 


DISEASES  DUE  TO  OCCUPATIONS.       151 

phorus  in  this  industry  entails  many  dangers  for  the 
workingman's  health.  The  disease  which  workingmen  in 
match  factories  chiefly  acquire  is  an  affection  of  the  jaw- 
bones, which  leads  to  sores  and  to  the  decay  of  the  bones. 
Persons  with  bad  teeth  are  particularly  in  danger.  In 
view  of  the  incidental  danger  this  industry,  at  its  begin- 
ning, was  forbidden  in  some  countries.  Only  gradually 
sanitary  measures  preventing  injury  became  known. 

Another  most  poisonous  metal  for  the  handling  worker 
is  lead.  It  is  variously  used,  for  glazing  in  potteries,  for 
paints,  etc. 

The  most  widely  known  disease  of  persons  working 
with  lead-containing  matter  is  lead  colic.  It  consists  of 
attacks  of  vehement  gripings  in  the  bowels,  especially 
about  the  navel,  and  persistent  constipation. 

At  a  higher  degree  of  lead  poisoning  there  appear 
pains  in  the  joints  similar  to  rheumatic  aches,  without, 
however,  changing  their  seats.  Next  paralysis  sets  in 
and  atrophy  of  muscles,  in  the  highest  grades  even 
deliriousness,  mental  depression,  and  epileptic  spasms. 

The  sanitary  rules  in  lead  works,  and  in  shops  where 
lead  is  handled,  should  be  very  stringent.  Especially  the 
raising  of  dust  in  the  shop,  or  at  the  machines  which  crush 
the  lead-containing  material,  is  severely  to  be  guarded 
against.  Youthful  workingmen  are  to  be  excluded  from 
employment  or  from  staying  in  works  where  lead  paints 
or  white  lead  are  manufactured. 

Aniline  factories  which  use  arsenic  are  dangerous  both 
for  the  workingmen  and  for  the  neighborhood,  arsenic 
being  one  of  the  strongest  mineral  poisons,  as  is  well 
known. 

Among  the  kinds  of  dust  inhaled  with  the  air  in  the 
shop  by  workingmen,  coal  dust  occupies  first  place  beyond 
all  doubt.  A  deposit  of  coal  dust  in  the  lungs — anthra- 


i5»  PASTORAL   MEDICINE. 

cosis  pulmomim — is  met  everywhere  where  the  lungs  are 
compelled  to  breathe  smoke  and  coal  dust  with  the  air. 
This  is  the  case  in  the  air  laden  with  tobacco  smoke  in 
crowded  saloons,  in  collieries  and  mines.  The  inhaled  dust 
incites  the  respiratory  organs  to  frequent  coughing  in 
order  to  get  rid  of  the  foreign  substances.  Therefore,  we 
frequently  meet  miners  afflicted  with  cough  and  mucus. 

A  prolonged  inhaling  of  coal  dust  seldom  fails  to 
produce  short-windedness  in  a  considerable  degree, 
caused  by  chronic  inflammation  in  the  lungs.  The 
pale  color  of  many  coal  dust  inhaling  workingmen  is  not 
only  caused  by  the  lack  of  oxygen  in  the  working  place 
(for  instance,  in  coal  mines),  but  also  by  the  deposited 
dust  contracting  the  capillary  vessels  in  the  delicate  pul- 
monary tissue,  and  thus  rendering  them  unfit  for  inhaling 
or  expelling  air. 

On  the  other  hand,  all  observers  emphasize  the  fact 
that  genuine  pneumonia  is  a  rare  disease  among  workers 
who  inhale  coal  dust.  Therefore,  there  is  a  tendency  to 
ascribe  to  coal  dust  a  specific  operation  against  tubercu- 
losis and  pneumonia. 

Regarding  the  various  kinds  of  coal  dust  and  the  trades 
in  which  they  are  inhaled  by  workingmen,  there  work 
in  an  atmosphere  containing  the  dust  of  the  charcoal, 
the  charcoal  burners,  the  coal  dealers,  the  firemen,  and 
the  workingmen  in  ultramarine  and  powder  factories. 
Anthracite  coal  dust  is  inhaled  by  miners,  trimmers,  fire- 
men ;  soot  by  chimney  sweepers  and  miners ;  graphite  by 
smelters  and  molders.  According  to  investigations  by 
Hirt  and  Lewin,  of  all  coal-inhaling  trades  it  is  among 
the  chimney  sweepers  where  the  best  health  conditions 
prevail. 

Another  kind  of  dust  inhaled  by  some  industrial  work- 
ingmen is  iron  dust.  Its  deposit  in  the  lungs  is  termed 


DISEASES  DUE  TO  OCCUPATIONS.       153 

siderosis  pulmonum.  The  symptoms  perceived  in  these 
workingmen  resemble  partly  those  found  in  coal  workers. 
On  the  other  hand  the  effects  of  metal  dust  are  far  more 
destroying  for  the  pulmonaric  tissue  than  coal  dust.  The 
number  of  consumptives  in  these  trades  is  extraordinarily 
large. 

Of  trades  where  metal  dust  is  breathed  are  next  in 
order  the  factories  which  prepare  the  peculiar  paper  used 
for  the  reception  of  gold  leaf.  Peroxid  of  iron  is  rubbed 
into  this  paper  with  a  piece  of  dry  felt,  whereby  an 
enormous  amount  of  dust  is  raised.  "  The  vitality  of  the 
girls  employed  at  this  trade,"  says  Merkel,  "  is  so  low 
that  it  is  only  astonishing  why  not  more  of  them  perish 
and  why,  again  and  again,  girls  are  found  who  heedlessly 
brave  the  very  same  danger." 

Particularly  detrimental  to  the  lungs  of  the  worker  is 
the  dust  developed  in  grinding  steel  wares.  It  is  a  mix- 
ture of  iron  and  sandstone.  This  most  noxious  species 
of  dust  is  raised  in  grinding  scissors,  knives,  forks,  pens 
and  needles  on  fast  rotating  grindstones,  with  2000  to 
3000  revolutions  in  one  minute. 

No  less  detrimental  to  the  lungs  of  the  workers  is  the 
influence  of  stone  dust,  particularly  of  quartz,  as  its  small- 
est particles  are  extraordinarily  hard,  splintery,  pointed, 
hence  hurting  in  the  highest  degree. 

Two  classes  are  especially  exposed  to  this  kind  of  dust : 
the  workmen  in  the  founding  mills  of  glass  factories, 
where  the  raw  material  for  manufacturing  glass  is  crushed 
to  a  dry  powder,  and  the  millwrights,  who  grit  the  mill- 
stones. The  age  average  of  these  workers  does  not  even 
reach  that  of  the  English  needlemakers — thirty-five  years. 

Nor  do  workingmen  exposed  to  tobacco  dust  present 
any  favorable  conditions  of  health.  The  likely  cause  is 
not  only  the  dust  inhaled,  but  other  competing  noxious 


i54  PASTORAL   MEDICINE. 

influences:  the  sitting  attitude,  want  of  fresh  air,  prema- 
ture and  excessive  smoking  in  leisure  hours,  and  lastly, 
the  fact  that  frequently  workingmen  of  feeble  health  look 
for  employment  in  cigar  and  tobacco  factories.  These 
unsanitary  conditions  prevail,  to  a  greater  extent,  where 
tobacco  is  worked  up  as  a  home  industry.  Then  the  work- 
room is  often  used  as  dwelling-room  for  the  family,  and 
as  kitchen.  The  atmosphere  therein  is  hardly  breathable 
if  the  lungs  are  not  accustomed  to  it. 

Among  the  poisonous  gases  inhaled  by  the  industrial 
workingmen  when  at  work  claims  our  attention  the  car- 
bonic gas,  in  everyday  life  called  merely  gas.  It  has  been 
dealt  with  in  the  first  part  of  this  work.  The  natural  and 
most  important  symptoms  of  poisoning  by  carbonic  gas 
are  affections  of  the  brain.  They  start  in  with  a  dull 
headache;  then  the  eyes  grow  dim,  dizziness  sets  in,  fol- 
lowed soon  by  a  total  and  long  unconsciousness.  Has  the 
poisonous  gas  been  inhaled  for  some  time,  then  the  poi- 
soned expires  without  having  regained  consciousness. 

To  the  danger  of  breathing  carbonic  gas  are  exposed 
the  workers  in  gas  plants,  on  conduits,  and  those  employed 
at  blast  and  coke  furnaces. 

Closely  related  to  carbonic  gas  is  carbonic  acid,  both 
in  regard  to  its  chemical  composition  and  in  regard  to  its 
operation  on  the  human  organism.  Gaseous  carbonic  acid, 
or  the  mixture  of  gases  wherein  it  is  prevalently  con- 
tained, develops  during  fermentation,  in  distilling  liquors, 
in  breweries,  in  the  fermentation  of  wine.  The  deadly 
gas  mixtures  in  old  tombs  or  in  wells  that  have  been 
closed  for  a  long  time  contain  a  preponderance  of  car- 
bonic acid  besides  small  quantities  of  sulphuretted  hydro- 
gen. Exposed  to  the  danger  of  inhaling  the  last  named 
poisonous  gas  are  the  workmen  in  sewers  and  canals  and 
the  tanners.  The  poisoning,  as  a  rule,  appears  suddenly, 


HYPNOSIS  AND   SUGGESTION.         155 

as  that  from  gas  in  wells.  The  worker  collapses  as  if 
struck  by  lightning,  and  he  will  be  past  rescue  if  not  re- 
moved at  once  from  the  operation  of  the  poisonous  gases. 

It  is  quite  natural  to  expect  a  particular  benefit  in  all 
unsanitary  occupations  from  preventive  measures.  But 
prejudice  and  ignorance,  heedlessness  and  lack  of  knowl- 
edge, want  and  poverty  are  competing  with  lack  of  con- 
science and  with  greediness,  to  render  prevention  here  as 
difficult  as  possible. 

As  there  will  be  little  success  from  the  instruction  of 
either  workingmen  or  employers  in  regard  to  the  preven- 
tion of  diseases,  we  must  arrive  at  the  conclusion  that  it  is 
necessary  for  the  government  to  frame  general  rules  for 
the  sanitary  safety  of  the  worker,  and  that  the  fulfilment 
of  these  laws  should  be  supervised  by  government  of- 
ficials. 

This  demand  for  the  workingmen's  safety  by  legal  pro- 
vision has  been  complied  with  more  or  less  by  all  civilized 
governments.  England,  in  this  respect,  is  ahead  of  them 
all.  Next  to  that  country,  Switzerland  has  enacted  the 
most  satisfactory  factory  laws. 

IV. — HYPNOSIS  AND  SUGGESTION. 

By  hypnosis*  is  understood  a  sleep-like  state  of  the 
nervous  system,  at  which  a  person  arrives  through  the 
agency  of  another  person,  the  hypnotizer.  The  hypno- 
tizer's  method  with  the  susceptible  person — medium — 
consists  either  of  the  command  to  stare  at  a  glittering 
object,  a  glass  button,  for  instance,  or  of  passes  with  his 
hands  over  the  medium's  forehead  and  extremities,  or 
even  in  the  hypnotizer's  simple  command,  "You  are 
tired;  close  your  eyes.  Now  you're  sleeping." 

f,  sleep. 


156  PASTORAL   MEDICINE. 

The  hypnotized,  upon  entrance  of  hypnosis,  continues 
in  the  attitude  last  assumed  before  falling  asleep.  He  is 
like  a  statue.  His  senses  are  suspended,  barring  the  hear- 
ing. Upon  the  hypnotizer's  proposing  (suggestion)  any 
part  of  the  central  nervous  system  may  be  set  in 
action  and  any  psychical  act  made  possible.  The  auto- 
matic mechanical  performance  ceases  as  soon  as  the  sug- 
gested order  has  been  executed.  The  retransfer  from  the 
hypnotic  into  the  lucid  state  is  easily  accomplished  by  the 
hypnotizer,  either  by  breathing  at  the  medium  or  by  the 
mere  command  to  wake  up.  Upon  awakening  the  hyp- 
notized has  no  recollection  of  what  has  occurred  during  his 
hypnosis.  Commands  by  the  hypnotizer  may  continue 
their  effect  upon  the  awakened,  e.  g.,  to  move  a  limb  that 
had  been  previously  stiff,  that  it  be  no  longer  paralyzed ; 
not  to  feel  pain  in  a  certain  part  of  the  body  which  had 
ached  before.  As  a  matter  of  course,  this  applies  ex- 
clusively to  such  state  of  paralysis  not  due  to  any 
anatomically  traceable  lesion  of  the  nerves,  for  instance, 
to  hysterical  paralysis.  No  hypnotizer  would  have  the 
power  to  revoke  by  suggestion  the  paralysis  due  to  a 
stroke  of  apoplexy. 

To  the  extent  of  the  observations  mentioned,  hypnosis 
is  employed  as  a  remedy.  It  was  this  striking  condition 
of  the  nervous  system  whereby  one  person  becomes  the 
helpless  tool  of  another,  which  raised,  some  twenty-five 
years  ago,  a  storm  of  excitement  in  Austria  and  Germany 
on  occasion  of  the  exhibitions  by  the  noted  hypnotizer 
Hansen.  A  stream  of  believing*  and  unbelieving,  of  edu- 
cated and  ignorant,  persons  poured  forth  every  night  to 
witness  the  performance.  The  programme  of  the  show 
was  always  one  and  the  same.  Hansen  invited  to  the 
platform  a  number  of  the  spectators  willing  to  be  experi- 
mented with,  placed  them  on  chairs,  their  backs  turned  to 


HYPNOSIS  AND   SUGGESTION.          157 

the  audience,  and  handed  a  glass  button  to  each.  Each  one 
was  told  to  fix  his  eyes,  and  stare  immovably,  at  the 
button  raised  close  to  the  forehead.  Hansen  himself 
went  from  one  object  to  the  other,  making  a  few  strokes 
and  passes  in  front  of  each  face.  Within  five  or  ten  min- 
utes one  or  the  other  among  the  objects  fell  into  a  hyp- 
notic state.  The  muscles  of  the  object  became  so  rigid 
that  it  was  possible  to  place  his  head  on  one  chair,  his 
heels  on  another,  keeping  the  rigid  body  thus  suspended. 
A  few  passes  by  the  hypnotizer's  hand  removed  the  rigor 
of  the  muscles — the  medium  woke  up. 

Another  hypnotized  object  was  handed  a  potato,  and 
was  told  it  was  an  apple.  To  the  great  amusement  of 
the  audience  the  object  ate  the  raw  potato  with  perceptible 
relish.  It  would  be  beyond  our  scope  to  dilate  upon  every 
number  on  the  programme  of  a  kindred  exhibition.  First 
of  all,  it  should  be  pointed  out  that  Hansen  brought  noth- 
ing new  to  the  surface.  His  manipulations  rest  on  ob- 
servations gleaned,  in  part,  from  the  practices  of  uncivil- 
ized nations. 

In  order  to  create  a  proper  susceptibility  of  nervous 
activity  by  concentrating  the  entire  attention  on  one  ob- 
ject, Hansen  made  use  of  a  glass  button. 

The  Yogies  in  India  provoke  an  ecstatic  condition  by 
Trataka,  i.  e.,  by  gazing  upwards,  the  priests  of  the 
Viti  Islanders  by  fixing  their  eyes  silently  and  calmly 
on  an  ornament  made  of  fish  teeth;  after  an  elapse  of 
a  few  minutes,  they  begin  to  convulse  and  to  tremble; 
they  mumble  and  groan — the  spirit  is  supposed  to  possess 
them;  in  full  paroxysm,  with  rolling  eyes  bulging  out, 
with  pale  and  contorted  features,  the  hierophant  proclaims 
the  revelations  received,  in  a  loathsome  voice.  In  similar 
fashion  are  inspired  the  oracles  of  spirits  on  Sandwich 
Islands,  Tahiti,  and  other  isles  in  the  Pacific  Ocean. 


158  PASTORAL   MEDICINE. 

Apparitions  quite  similar  to  those  produced  by  Hansen 
were  called  forth  by  Mesmer  toward  the  end  of  the 
eighteenth  century  with  the  aid  of  big  so-called  magnetic 
bathtubs,  by  passes,  etc.  Mesmer  ascribed  his  suc- 
cesses to  his  discovery  of  a  mysterious  fluid,  the  so-called 
animal  magnetism,  or  magnetism  of  life.  Existing  as  mov- 
ing agency  everywhere  in  space,  this  fluid  was  thought  to 
be  communicated  as  a  healing  power  from  the  magnetizer 
to  the  object,  through  the  appliances  mentioned.  This 
novel  theory,  clothed  with  much  unsound  mysticism, 
gained  ground  rapidly,  but  also  was  vehemently  antago- 
nized in  medical  academies  and  societies,  which  sharply 
condemned,  time  and  again,  Mesmer's  conduct. 

Dr.  James  Braid,  of  Manchester,  in  1841,  propounded 
an  entirely  novel  theory  of  animal  magnetism,  whereby  he 
became  the  real  discoverer  of  hypnotism.  Braid  proved  by 
his  experiments  that  the  magnetizer  does  not  communicate 
to  the  object  a  mysterious  force  which  emanates  from  him- 
self, but  that  the  object  by  himself  can  assume  a  strange 
sleep-like,  sometimes  somnambulic,  state  wherein  he  thinks 
to  have  a  distinct  sensation  not  only  of  spontaneously  oc- 
curring presentations,  but  also  of  those  which  were 
called  forth — suggested — by  the  hypnotizer.  This  con- 
dition, produced  by  staring  at  an  object,  is  really  due 
to  qualities  and  faculties  innate  to  his  nervous  sys- 
tem. Braid's  discoveries  gave  rise  to  all  sorts  of 
erroneous  and  barren  speculations,  as  was  the  case  with 
Mesmer's  findings.  Again  and  again  the  facts  of  hyp- 
notism were  overhung  with  certain  mystic  accessories 
born  by  superstition  and  humbug. 

In  his  work  "  Du  someil  et  des  etats  analogues/'  Lie- 
bault,  of  Nancy,  furnished  the  proof  that  the  strange 
sleep-like  condition,  termed  hypnosis,  is  not  called  forth 
by  a  mechanical-physical  process,  like  the  tiring  of  the 


HYPNOSIS   AND   SUGGESTION.          159 

eyes  from  staring,  or  by  the  soothing  effect  of  a  gentle 
stroke  upon  the  nerves  of  the  skin,  or  similar  manipula- 
tions, but  only  and  solely  by  the  idea  produced  in  the 
medium  that  it  must  sleep;  furthermore,  that  all  other 
seemingly  natural  effects  of  hypnosis,  as  the  rigor  of 
muscles  or  the  insensibility  of  the  skin,  are  caused  solely  by 
suggestion,  which  the  one  experimenting,  expressly  or 
implied,  communicates  to  the  object.  Where  no  direct 
words  are  uttered  in  suggesting,  then  the  object  guesses 
from  certain  circumstances  or  hints,  or  from  previous  ex- 
periences, what  the  hypnotizer  expects.  If,  for  instance, 
he  lifts  the  medium's  arm,  it  will  in  most  cases  fall  down 
again.  If,  however,  the  arm  is  lifted  a  second  time,  then 
the  medium  rightly  assumes  that  the  hypnotizer  de- 
sires the  arm  to  remain  in  the  given  position.  Sugges- 
tion, whether  communicated  directly  or  indirectly,  is  the 
kernel  and  the  hinge  of  all  effects  caused  by  hypnosis,  and 
hypnotism  itself  is  nothing  else  but  a  condition  of  en- 
hanced suggestibility,  caused  by  suggestion. 

To  employ  hypnotism,  respectively  suggestion,  for 
medical  purposes,  should  only  be  allowed  to  an  expert 
physician  who  conscientiously  takes  all  corporeal  and 
mental  conditions  of  the  patient  into  account. 

It  is  evident  that  such  a  variation  of  a  person's  nervous 
life  at  the  hands  of  impostor,  or  an  ignoramus,  may 
cause  great  injury,  personal  and  general.  This  applies 
especially  to  public  experiments  and  shows.  The  persons 
used  as  objects  in  such  demonstrations  are  impaired  in 
their  corporeal  and  mental  health  by  negligent,  unsuitable, 
careless  and  too  frequent  hypnotizing.  An  authority 
on  the  matter  remarked  in  a  discourse  on  origin  and 
cure  of  hypnotic  diseases :  "  The  state  of  hypnosis  con- 
sists in  an  expressly  provoked  loosening,  even  in  partly 
unfastening,  the  normally  fast  ties  between  psychical  and 


160  PASTORAL   MEDICINE. 

corporeal  events.  But  if  loosened  once,  or  even  fre- 
quently, this  tie  undoubtedly  loses  its  enduring  security, 
hence  persons  repeatedly  hypnotized  are  in  danger  that 
similar  conditions  may  occur  for  some  reasons  not  con- 
templated or  foreseen  by  the  hypnotizer.  The  very  state 
of  hypnosis  must  unconditionally  be  looked  upon  as  some- 
thing abnormal,  something  morbid.  Exactly  the  same 
symptoms,  as  expressly  provoked  in  hypnotizing,  are 
known  to  the  physician  as  primary  symptoms,  by  no  means 
rare,  of  morbid  conditions,  caused  naturally  by  a  mental 
disorder,  which  he  terms  hysteria.  Hypnotic  conditions 
and  symptoms  of  hysteria  in  their  inner  nature  are  most 
closely  related.  Hypnosis  is  nothing  else  but  an  artificially 
provoked  hysteria.  .  .  .  Hypnotism  remains  ever  a 
double-edged  sword,  which  can  do  much  harm,  especially 
if  not  altogether  judiciously  used.  This  has  been  shown 
by  experience  time  and  again." 

The  sense  for  decency  and  propriety  disappears  by 
public  exhibitions,  or  becomes,  at  least,  greatly  impaired. 
Those  present  during  the  experiments  run  the  risk  of  ac- 
quiring morbid  nervous  conditions,  by  looking  at  the 
mediums  who  lend  themselves  for  these  demonstrations. 

De  La  Tourette  reports  that  after  the  public  exhibition 
by  the  Magnetizer  Donate,  in  the  winter  of  1880-1881,  in 
French  Switzerland, a  real  magnetic  epidemic,  "magnetism 
mania,"  made  its  appearance.  The  very  same  was  noticed 
in  Breslau  after  Hansen's  seances,  especially  among 
young  people.  At  the  fifty-third  convention  of  German 
scientists  and  physicians,  at  Danzig,  1880,  the  case  of  an 
artillery  officer  was  related  who  was  so  susceptible  that 
he  could  not  attend  a  seance  without  running  the  risk  of 
becoming  hypnotized. 

As  a  result  of  these  consequences  public  exhibitions  of 
hypnotizers  are  prohibited  in  many  countries. 


HYPNOSIS   AND   SUGGESTION.          161 

The  fact,  finally,  that  while  in  hypnotic  state  a  person 
may  be  exposed  to  assaults  should  not  be  overlooked. 

Attention  has  furthermore  been  directed  to  alleged  crim- 
inal possibilities  of  hypnotism,  which  are  quite  fallacious. 
This,  furthermore,  is  equally  the  case  with  another  excres- 
cence which  has  shot  up  on  French  soil.  Since  these  crini- 
inal  possibilities  will  be  of  interest  to  the  priest  in  the  con- 
fessional, we  shall  here  devote  some  attention  to  them. 

The  French  physicians  Bernheim  and  Liegois  asserted 
that  a  hypnotized  person  can  be  commanded  by  sugges- 
tion to  commit  a  crime,  and  that  upon  awakening  from 
the  hypnotic  state  the  person  in  question  can  not  help  com- 
mitting the  ordered  deed.  Hence  that  person  can  evi- 
dently not  be  charged  with  the  crime,  neither  by  the  crim- 
inal judge  nor  by  his  own  conscience. 

These  and  kindred  views  of  men  who  had  made  of 
hypnotism  a  particular  study,  incited,  when  first  pub- 
lished, a  widespread  dispute,  and  disturbed  the  peace  of 
the  minds  to  a  large  extent.  Searching  investigation  and 
unbiased  weighing  of  the  alleged  facts,  however,  soon 
disclosed  that  the  originators  of  these  views  were  en- 
meshed in  the  most  flagrant  contradictions,  and  that  they 
were  unable  to  produce  even  a  single  attested  case  from 
real  life  to  support  their  "  laboratory  theory,"  if  it  is  per- 
missible to  use  this  term. 

At  the  sixty-first  Congress  of  German  Physicians,  at 
Cologne,  this  heresy  of  Bernheim  was  refuted  as  "  in  no 
ways  borne  out  by  fact,  and  belonging  to  the  realm  of 
visions."  Bernheim's  teachings — in  which  he  sees  the  ef- 
fects of  suggestion  everywhere:  all  our  thoughts,  deeds, 
and  actions  are  suggested — were  even  refuted  by  his  own 
fellow-countryman,  Dr.  Gilles  de  la  Tourette. 

In  concluding,  suggestion  incites  also  our  interest  inas- 
much as  it  was  brought  forward  as  an  explanation  for 


PASTORAL   MEDICINE. 

many  extraordinary  cures,  which  occurred  at  places  of  pil- 
grimage, for  instance,  at  Lourdes.  The  above  mentioned 
student  of  hypnotic  conditions,  Professor  Bernheim,  of 
Nancy,  who,  of  course,  is  prone  to  trace  back  all  psychical 
processes  to  suggestion,  has  this  to  say  anent  the  miracu- 
lous cures  at  Lourdes :  "  It  is  not  my  intention  to  attack 
religion  or  to  hurt  the  feelings  of  the  faithful  in  ex- 
amining these  credible  reports  of  cures  at  Lourdes  and  in 
trying  to  disrobe  them  in  the  name  of  science  of  their 
character  of  miracle.  My  object  in  view  is  merely  to 
bring  about  a  comparison  between  religious  suggestion 
and  hypnotic  suggestion. 

"  There  is  no  doubt  that  all  these  reports  were  collected 
in  a  spirit  of  truth  and  were  tested  by  honorable  men. 
The  facts  are  correct;  their  explanation  may  have  been 
erroneous." 

Charcot,  one  of  the  most  famous  French  neurologists, 
every  year  sent  many  of  his  patients  to  the  spring  of  grace. 
According  to  an  article  in  "  Archives  de  Neurologic"  he 
had  no  doubt  that  even  wounds,  sores,  cancer,  etc.,  can  be 
cured  at  those  places  of  pilgrimage ;  but  he  believes  that 
these  processes  are  founded  on  hysteria,  and  that  the 
morbid  symptoms  may  appear  and  disappear  upon  sugges- 
tion. But,  finally,  he  honestly  admits  that  even  to-day 
there  are  many  things  on  earth  which  can  not  be  ex- 
plained by  our  philosophy.  Leaving  out  entirely  the  mor- 
bidities of  the  nervous  system,  it  is  not  difficult  for  the 
unbiased  observer,  who  has  been  at  the  sick  bed  and  the 
dissecting  table,  to  decide  the  question  where  the  greatest 
sacrifice  of  intellect  comes  in :  if  he  is  to  assume  a  cancer, 
a  caries,  a  fungus,  has  been  made  to  come  and  go  by  sug- 
gestion, or  that  it  has  been  cured  by  a  miracle. 

Reviewing  the  above,  we  arrive  at  the  following  con- 
clusions : 


'ALCOHOLISM.  163 

1.  The  striking  mutation  of  the  nervous  system,  termed 
hypnosis,    rests   on   natural   proceedings    and    lacks    all 
those  mystic-spiritistical  trimmings,  with  which  the  rep- 
resentatives of  animal  magnetism  (mesmerism,  braidism) 
tried  to  clothe  it. 

2.  The  exhibition  in  public  of  hypnotic  experiments  on 
persons  is  decidedly  to  be  prohibited,  for  the  sake  of 
morality  and  public  health. 

3.  Hypnotizing  for  the  purpose  of  effecting  cures  should 
only  be  permitted  to  expert  physicians. 

4.  Hypnotic  state  exposes  persons  to  the  danger  of 
assaults. 

5.  The  doctrine,  propagated  in  some  quarters,  that  sug- 
gestion abolishes  the  free  agency  of  a  person,  inasmuch 
as  an  irresistible  impulse  to  a  deed,  especially  a  crime, 
may  be  suggested  to  the  hypnotized,  is  erroneous. 

6.  While  suggestion  may  play  a  part  in  allaying  mor- 
bid conditions,  as  an  explanation  of  miraculous  cures  it 
is  entirely  inadequate. 


V. — ALCOHOLISM. 

By  alcoholism  (abusus  spirit uosorum)  those  aggre- 
gated morbid  signs  and  tokens  are  understood  which  are 
the  effects  of  long  continued  abuse  of  liquors.  The  his- 
tory of  the  abuse  of  alcoholic  beverages  is  part  of  the 
history  of  civilization  of  mankind.  True,  the  ancients 
and  our  forefathers  certainly  did  practise  riotous  libations 
in  honor  of  Bacchus,  yet  this  insobriety  never  exercised 
that  destroying  influence  upon  the  corporeal  and  mental 
welfare  of  the  broad  masses  of  the  people  as  does  the 
vice  of  drunkenness  in  modern  times.  Our  ancestors 


i64  PASTORAL   MEDICINE. 

quaffed  nothing  worse  than  wine  and  beer ;  moreover,  of 
low  alcoholic  grade.  The  abuse  of  spirits  only  became  a 
general  vice  with  the  introduction  of  spirituous  liquors. 
Its  production  is  to  be  traced  back  to  the  Moors  in  Spain, 
as  its  name  (al-cohol)  indicates.  The  Arabian  physician 
Abdul  Kasim,  of  Cordova  (died  in  1106),  speaks  posi- 
tively of  liquor  obtained  by  distillation. 

Drunkenness  makes  a  person  ill,  bodily  and  mentally, 
and  acts  destructively  in  ethical  and  social  direction. 

(a)  Somatic  effects  of  Drunkenness. 

Persons  given  to  the  abuse  of  liquors  fall  more  easily 
sick  and  die  at  an  earlier  age  than  moderate  drinkers  and 
abstainers.  Habitual  and  excessive  use  of  alcohol  de- 
teriorates the  entire  constitution  of  the  body.  Hence 
vitality  and  resisting  power  to  morbid  agents  is  lowered. 
In  times  of  epidemics  (cholera,  dysentery,  pox)  drunkards 
are  among  the  first  to  fall  sick  and  succumb  to  the  attack 
in  a  large  number.  Furthermore,  a  drinking  man  falls 
a  prey  to  an  acute  febrile  disease  more  easily  than  the 
non-drinker. 

This  fact  is  proven  by  statistics  compiled  from  reports 
of  certain  individual  life  insurance  companies  in  England, 
which  have  two  divisions :  one  for  insured  total-abstainers 
from  liquor,  the  other  for  non-abstainers.  The  death  list 
in  the  abstinence  section,  for  a  space  of  ten  years,  amounted 
to  but  seventy-one  per  cent,  of  the  anticipated  death  cases ; 
in  the  second  section,  however,  the  percentage  was  ninety- 
seven.  Hence  the  number  of  deaths  in  the  former  division 
was  twenty-six  per  cent,  less,  i.  e.,  over  one-quarter  less 
than  in  the  second. 

According  to  recent  experiences  of  an  assurance  com- 


ALCOHOLISM.  165 

pany  in  Scotland  there  occurred  among  862  insured  tavern 
and  innkeepers  215  death  cases,  while,  according  to  the 
mortality  list  of  the  company,  only  142  death  cases 
were  to  be  expected.  Hence  this  trade  evinces  an  over- 
mortality  amounting  to  fifty  per  cent. 

The  following  remarkable  statistics  anent  the  effects  of 
the  abuse  of  liquor  were  compiled  by  the  Revue  Sanitaire 
de  Bordeaux.  The  annual  mortality  in  England  among 
males  between  the  ages  of  twenty-five  and  sixty-five  years 
reaches : 

Among  Per  cent. 

Priests     8.05 

Farmers    9.78 

Farm  laborers  1 1.86 

Inhabitants  of  the  most  healthy  sections. .   12.46 

Carpenters  and  joiners   12.71 

Coal  miners  13.81 

Bricklayers *4-92 

Lead  workers,  glaziers,  painters 18.63 

Brewers    21.09 

Innkeepers   23-57 

Help  in  public  houses 34-I5 

Hence,  hard  labor,  by  which  a  man  earns  his  daily 
bread,  proves  less  detrimental  than  the  abuse  of  liquors. 
Bad  food,  poor  clothes,  foul  air,  unsound  dwellings  are 
less  harmful  than  alcohol.  Even  leadworkers,  while 
handling  poisonous  material,  are  better  off  than  brewers, 
tavern  keepers,  and  the  help  in  public  houses.  Taking 
the  aggregate  years  of  life  reached  by  14,176  male  per- 
sons, who,  in  their  capacity  as  restaurant,  tavern,  and  inn- 
keepers, brewers,  waiters,  etc.,  had  been  more  or  less  ad- 
dicted to  the  abuse  of  intoxicating  beverages,  and  compar- 


1 66  PASTORAL   MEDICINE. 

ing  this  total  with  the  total  of  years  attained  by  per- 
sons taken  from  the  general  population,  and  from  trades 
injurious  to  health,  all  these  persons  having  died 
at  a  corresponding  age,  Baer  has  come  to  the  conclusion 
that  "  the  vitality  of  persons  of  the  first-named  callings  at 
the  age  of  thirty  is  less  than  that  of  an  ironworker,  and  at 
thirty-five  about  equal  to  that  of  a  filecutter.  This  pro- 
portion bears  testimony  of  how  the  habitual  use  of  alcohol 
impairs  health  and  shortens  life,  even  when  not  used  to 
excess." 

The  intemperate  use  of  spirits  affects  a  person  in  an 
acute  manner  thus^  that  upon  the  stimulation  at  first  of 
physical  and  mental  capacity,  there  follows  a  paralysis  of 
voluntary  muscles  and  of  the  cerebral  functions  (intoxica- 
tion, poisoning  by  alcohol).  At  the  highest  degrees  of 
intoxication,  death  by  apoplexy  is  nothing  uncommon. 

The  chronic  effects  of  alcoholic  abuse  are  made  evident 
in  the  first  place  in  the  digestive  organs,  where  the 
pituitaries  are  directly  brought  in  contact  with  the  stimu- 
lating liquid.  Catarrhal  affections  of  throat  and  stomach 
are  soon  in  order,  appetite  decreases,  thirst  increases. 
With  empty  stomach,  especially  in  the  morning,  a  chok- 
ing and  heaving  sensation  is  felt.  Next,  the  liver  is 
attacked,  gathering  a  morbid  layer  of  fat.  With  pro- 
gressed drunkenness,  this  organ  shrinks,  which  is  espe- 
cially the  case  with  whisky  drinkers.  In  most  cases  the 
kidneys,  too,  are  affected,  and  form,  together  with  the 
diseased  condition  of  the  liver,  the  foundation  for  dropsy. 
This  malady,  and  pneumonia,  constitute  equally  often  the 
last  tableau  in  the  course  of  a  body  ruined  from  sottish- 
ness. 

Drunkenness  not  alone  undermines  the  health  of  the 
drunkard,  its  detrimental  effects  extend  also  to  the  issue 
of  drunkards. 


ALCOHOLISM.  167 

First  of  all,  it  has  been  established  by  expert  scientists 
that  children  begotten  in  a  state  of  intoxication  either  are 
vastly  predisposed  to  mental  disorders,  or  are  born  idiots, 
or  perish  soon  of  a  weak  vitality.  According  to  Darwin, 
the  family  of  drunkards  becomes  extinct  in  the  fourth 
generation. 

Demme  compiled  the  following  evidence  of  the  in- 
fluence exercised  by  parent-drunkards  upon  vitality  and 
health  of  their  issue :  He  took  ten  hard  drinking  families 
and  contrasted  them  with  ten  others  of  unquestionable 
sobriety.  The  direct  issue  of  the  ten  drinking  families 
amounted  to  fifty-seven  children.  Of  these,  twenty-five 
died  within  their  first  weeks  or  months  of  life,  six  were 
idiots,  five  children  were  noticeably  slow  in  growing, 
five  suffered  from  epileptic  fits,  five  from  innate  diseases. 
One  boy  became  afflicted  with  St.  Vitus'  dance  and 
ended  as  an  idiot.  Hence,  of  the  fifty-seven  children  by 
drunkards  there  were  only  ten,  or  17.5  per  cent.,  in 
whom  normal  faculties  and  developments  were  noticed. 

The  ten  temperate  families  produced  sixty-one  children, 
of  whom  but  five  died  off  within  the  first  weeks,  four  suf- 
fered from  curable  affections  of  their  nervous  systems; 
only  two  children  evinced  innate  defects.  The  remaining 
fifty,  81.9  per  cent.,  presented  normal  faculties  and  devel- 
opment. 


Effects  of  drunkenness  in  the  psychical  sphere. 


Abuse  of  alcohol  is  preeminently  detrimental  to  the 
organ  of  the  mental  life :  to  the  brain,  both  in  regard  to  its 
structure  and  to  its  functions.  The  drunkard's  powers  of 


1 68  PASTORAL   MEDICINE. 

perception  and  of  reasoning  become  blunted,  the  will 
power  abates. 

Drunkenness  plays  a  predominant  part  in  diseases  of 
the  mind.  One-quarter  of  all  inmates  of  insane  asylums 
are  drunkards,  according  to  the  concurring  observations 
by  all  specialists  of  experience.  In  many  instances  a  par- 
ticular psychosis  grows  upon  the  soil  of  chronic  alco- 
holism, the  origin  of  which  is  simply  due  to  drunkenness. 

Where  there  is  a  predisposition  to  mental  morbidity, 
the  abuse  of  liquors  promotes  the  development  of  the 
lurking  disease.  Such  persons  are  strikingly  susceptible 
for  the  effects  of  liquors.  Small  quantities  suffice  to 
produce  symptoms  of  heavy  intoxication  (pathological  in- 
toxication). One  of  the  most  frequent  intercurrent  mal- 
adies due  to  chronic  alcoholism  is  the  delirium  tremens 
potatorum.  As  implied  by  the  name  itself,  its  fundamental 
signs  are  deliriousness  and  shaking,  accompanied  by  in- 
somnia and  hallucinations. 

As  casual  causes  for  the  outbreak  of  the  delirium  must 
be  considered  all  debilitations,  which  further  enfeeble  the 
drunkard's  already  impaired  and  unresisting  brain.  The 
principal  casual  causes  are  frequent  debauches  (a  potu 
nimio),  deprivation  of  liquor  for  the  habitual  stimulation 
of  the  nerves  (a  potu  inte rmissio ) ,  insufficient  food,  acute 
febrile  diseases,  particularly  pneumonia,  external  injuries, 
fractured  bones.  Preceded  by  forerunners,  such  as  irrita- 
bility, oppression  about  the  cardiac  region,  restless  sleep, 
headache,  dizziness,  the  real  malady,  delirium,  breaks 
out  a  few  days  later.  Dullness  of  mind  is  followed  by 
delusions,  hallucinations,  at  first  only  after  dark,  later 
also  in  daylight.  They  consist  chiefly  of  visions  of  ani- 
mals. The  patients  imagine  themselves  surrounded  and 
beset  by  rats,  mice,  dogs,  horses,  in  masses.  They  lack 
sleep  entirely. 


ALCOHOLISM.  169 


(c)  Effects  of  drunkenness  in  ethical  respects. 


Experience  teaches  that  habitual  drunkenness  at  first 
decreases  in  a  specific  way  the  moral  qualities  of  man,  and 
destroys  them  gradually.  The  drunkard's  sense  of  honor, 
duty,  decency,  and  manner  becomes,  by  and  by,  extin- 
guished. Self-control  of  the  intoxicated  is  impaired ;  lusts 
and  impulses  rise,  stronger  and  more  commanding;  re- 
straint by  will  and  reflection  is  utterly  out  of  question. 
Enlarged  self-esteem  makes  the  intoxicated  quarrelsome 
and  more  sensitive ;  the  latter  quality  again  prompts  him 
to  act  hastily,  to  take  prompt  revenge  for  an  offered  insult, 
real  or  imaginary. 

Hence  criminal  courts,  judges,  and  prosecutors,  are  well 
aware  of  drunkenness  and  crime  being  cause  and  effect, 
and  find  this  truism  borne  out,  over  and  over  again,  by 
their  daily  experience. 

An  authority,  Dr.  Krohne,  director  of  a  penitentiary, 
describes  the  connection  between  drunkenness  and  crime 
as  follows: 

"  Of  the  criminal  assaults  upon  body  and  life,  the 
resulting  simple  or  grave  injuries  are  entirely,  those  not 
deliberate  in  the  assault,  but  merely  accidental,  are  almost 
entirely,  manslaughter,  voluntary  or  involuntary,  with 
but  few  exceptions  due  to  liquor.  In  many  murder  cases 
the  courts  find  liquor  to  be  the  cause  for  the  crime. 

Crimes  against  morality,  be  they  rape,  malpractice 
with  children  or  adults,  etc.,  are  almost  exclusively  due 
to  liquor."  The  same  authority  arrives  at  the  result  that 
seventy  per  cent,  of  all  crimes  and  misdemeanors  com- 
mitted are  originally  more  or  less  connected  with  liquor. 


170  PASTORAL   MEDICINE. 

(tf)  Social  effects  of  drunkenness. 

Drunkenness  is  the  most  prevalent  cause  of  pauperism. 
As  the  French  physician  Picard  says,  "  Poverty  and 
misery  follow  everywhere  in  the  wake  of  insobriety,  like 
a  shadow  follows  the  body.  On  the  very  day  when  drunk- 
enness shall  have  vanished,  the  larger  half  of  pauperism 
will  also  have  disappeared."  In  1885  62  per  cent,  of  all 
persons  supported  by  public  charities  in  Germany  had 
been  pauperized  by  drinking. 

This  connection  between  pecuniary  distress  and  drunk- 
enness need  astonish  no  one  who  stops  to  consider  that 
some  workingmen  spend  four-fifths  or  more  of  their 
daily  earnings  for  liquor  or  beer.  How  much  remains, 
then,  for  rent,  clothes,  and  food? 

Drunkenness  undermines  family-life.  The  drunkard 
can  not  find  recreation  at  home  with  his  family,  at  least, 
none  that  satisfies  him.  He  must  go  into  the  saloon. 
By  staying  in  the  saloon,  he  neglects  his  duties  toward 
his  family.  His  craving  for  liquor  soon  absorbs  all  his 
means.  His  folks  are  put  in  want  and  misery.  Upon 
returning  home,  the  drunkard,  still  under  the  influence  of 
liquor,  possibly  somewhat  conscience-stricken,  is  easily 
irritated,  and  only  too  often  gives  vent  to  his  irri- 
tability in  dealing  with  his  family.  The  sufferings  of  wife 
and  children  of  a  drunkard  deserve,  in  many  instances,  a 
crown  of  martyrdom.  Sometimes  these  family  members, 
through  despair  and  bad  example,  are  also  driven  to  drink. 

In  view  of  these  pernicious  effects  of  drunkenness  upon 
the  populace,  clergymen,  lawyers,  physicians,  and  social 
economists  have  maintained  unanimously  at  all  times  that 
something  must  be  done  to  curb  drunkenness.  "  In  recent 
times,"  to  quote  from  Paulsen's  System  of  Ethics, 
"  among  earnest  and  thinking  men  the  conviction  gains 


ALCOHOLISM.  171 

more  and  more  ground  that  in  intemperance  there  lies  an 
extraordinary  danger  for  the  entire  further  development 
of  life  among  civilized  nations.  How  shall  we  meet  it?  " 

As  a  preventive  it  has  been  justly  recommended  to 
begin  early,  with  the  growing  young  people.  They  should 
be  warned  of  drunkenness  as  being  a  vice  noxious  to 
body  and  soul.  A  powerful  influence  in  this  direction  can 
especially  be  exerted  by  the  Catechist  in  school. 

Looking  around,  first  of  all,  among  working-people,  in 
our  search  for  preventives,  we  note  that  all  such  associa- 
tions that  have  for  their  object  the  saving  of  money,  as 
for  instance  building  and  loan  associations,  are  efficient 
antidotes  against  the  poison  of  drink. 

Considerable  influence  in  the  same  direction  must  be 
attributed  also  to  the  working-girls'  associations,  where 
working-women  receive  tuition  and  training  in  house- 
keeping and  in  female  handicraft.  Well-trained,  domestic 
wives  keep  their  husbands  to  sobriety  and  thrift.  Proofs 
of  the  opposite  can  be  found  in  abundance  in  everyday 
life. 

An  indispensable  armament  in  the  war  against  drunk- 
enness are  the  temperance  societies.  They  were  founded 
at  the  end  of  the  eighteenth  and  the  beginning  of  the 
nineteenth  century,  at  first  in  America  and  England. 
The  abuse  of  liquors  in  both  countries  had  assumed  such 
proportions  that  something  had  to  be  done  to  curb  the 
evil.  The  members  of  these  societies  abstain  altogether 
from  spirituous  liquors  and  endeavor  by  word  and  ex- 
ample to  gain  additional  converts  to  the  cause  of  ab- 
stinence. 

In  combating  against  the  abuse  of  alcohol  it  became 
the  duty  of  the  government  to  reduce  the  opportunity  to 
obtain  liquor. 

The  plan  of  limiting  the  production  of  alcohol,  as  ad- 


172  PASTORAL   MEDICINE. 

vocated  formerly,  is  to  be  dismissed  for  political  eco- 
nomical reasons. 

On  the  other  hand,  government  has  an  effective  means 
of  reduction  at  its  disposal — limiting  the  selling  places, 
restricting  the  sale  of  liquor  to  certain  hours  of  the  day, 
and  by  a  large  prohibitive  tax. 

Finally,  it  is  the  duty  of  the  government  to  provide 
that  only  pure  and  unadulterated  liquors  are  sold.  Par- 
ticularly should  only  those  spirits  be  allowed  to  be  sold 
for  drinking  purposes  which  are  free  from  fusel  oil. 

To  liberate  the  drunkard  from  his  pernicious  passion 
there  is  usually  no  other  means  than  his  stay  in  a  drunk- 
ard's asylum.  Here,  apparently,  lies  yet  an  open  field  for 
the  activity  of  the  religious  orders,  which  might  be  en- 
tered not  without  success. 


VI. — MORPHINISM. 

Morphinism  is  the  term  applied  to  the  passion  of  a 
person  for  morphine  as  a  stimulant  or  a  relish,  because 
they  are  unable  to  forego  the  medicament  without  disturb- 
ing their  condition  or  well  feeling.  The  term  is  also  used 
to  express  the  state  of  sickness  engendered  by  the  mis- 
use of  that  medicine.  Morphia  is  the  most  important  con- 
stituent of  the  milky  juice  of  the  white  poppy,  papaver 
somniferum.  Its  effect  upon  the  human  body  is  ex- 
pressed in  the  ominous  words:  It  mitigates  pain  and 
brings  sleep.  These  effects  are  quickened  if  the  medicine 
is  not  introduced  in  the  stomach,  but  injected  subcu- 
taneously  with  a  hypodermic  syringe. 

The  beneficial  influence  of  subcutaneous  injections  of 
morphia  on  wounded  and  sick  became  especially  apparent 
in  Germany  during  the  war  of  1866.  Since  then  it  has 


MORPHINISM.  173 

been  ever  more  widely  used.  The  technique  of  injection 
being  easy  to  acquire,  the  physician  soon  lost  control  of  the 
remedy,  which  fell  in  the  hand  of  the  laity,  the  patient. 
Thus  the  fatal  step  was  done.  For  injected  morphia  not 
only  abates  insomnia  and  bodily  pain ;  it  transforms  at  the 
same  time  the  whole  person,  producing  a  state  of  agreeable 
excitement  which  is  analogous  only  to  the  effect  of 
alcohol. 

The  mood  changes,  the  gloomy,  through  morphia-in- 
jection, becomes  cheerful;  it  imparts  force  to  the  faint, 
energy  to  the  weakling,  in  brief,  self-consciousness,  con- 
fidence in  one's  own  power  and  ability  is  heightened. 

With  the  excernment  of  morphia  from  the  body  there 
follows,  however,  a  state  of  deep  depression.  There  is 
no  other  saving  clause  to  lead  out  of  this  wretched  state 
but  the  helpful  syringe,  to  which  the  morphia  fiend  has 
recourse,  as  the  sot  to  the  liquor  flask,  to  raise  his  de- 
pressed spirits,  to  sharpen  his  wits,  and  to  steady  his 
trembling  limbs.  To  achieve  the  longed-for  result  it  is 
necessary  to  steadily  increase  the  doses,  because  the  organ- 
ism gets  used  to  the  poison.  Thus,  the  morphia  fiend  is 
compelled  to  put  always  larger,  frightening  large,  quan- 
tities into  his  body,  till  he  becomes  a  mental  and  physical 
wreck. 

The  morphia  habit  recruits  its  victims  almost  exclu- 
sively from  the  more  cultured  and  higher  circles  of  so- 
ciety. The  impecunious  who  only  learn  to  know  morphia 
at  the  hand  of  the  physician  or  at  the  hospital  are  in  no 
position  to  obtain  the  medicine  after  their  discharge  as 
cured. 

Persons  that  acquire  the  morphia  habit  are  preponder- 
antly physicians ;  then  follow  druggists  and  army  officers. 
The  female  sex  is  also  disposed,  in  a  high  degree,  to  the 
misuse  of  morphia  injections. 


174  PASTORAL   MEDICINE. 

The  sole  curative  against  the  habit  is  to  deprive  the 
victims  .of  their  accustomed  stimulant.  Such  a  cure  is, 
however,  only  possible  in  a  well  managed  institution,  and 
it  is  accompanied  by  violent  pains,  both  corporeal  and 
psychical. 

Many  persons  cured  of  the  morphia  habit  develop  a 
desire  for  alcohol,  and  thus  encounter  a  new  danger. 


THIRD   PART. 
FIRST  AID  TO  THE  INJURED.* 

I. — HEMORRHAGE  AND  ITS  IMMEDIATE  TREATMENT. 

DEFINITION. — Hemorrhage  may  be  defined  as  the  escape  of 
blood  from  the  heart  or  the  blood-vessels. 

THE  CAUSES  are:  (i,)  Injury;  (ii,)  Disease. 

THE  SITUATION.— Hemorrhage  may  be  either:— 

(i,)  External. — This  is  most  frequently  the  result  of  injury. 

(ii,)  Internal. — This  is  generally  due  to  disease. 

THE  SYMPTOMS  of  Hemorrhage  are:— The  actual  appear- 
ance of  blood  (which  is  always  seen  in  external  hemorrhage, 
while  in  internal  hemorrhage  blood  may  also  reveal  its  presence 
— e.  g.,  in  bleeding  from  the  lungs,  etc.),  and  the  constitutional 
effects,  more  or  less,  which  follow  the  loss  of  blood,  i.  e.,  the  signs 
of  syncope  or  fainting,  which  are  indicated  by  a  cold  and  clammy 
skin,  a  pallid  and  livid  face,  dilated  pupils,  feeble  and  irregular 
breathing,  an  irregular  and  almost  imperceptible  pulse,  dizzi- 
ness, inclination  to  vomit,  and  loss  of  consciousness.  These  con- 
stitutional effects  are  in  proportion  to  the  suddenness  of  the  loss 
of  blood,  i.  e.,  the  quicker  the  loss,  the  more  profound  the  syncope. 

VARIETIES  of  Hemorrhage.— The  severity  of  the  bleeding 
varies  with  the  portion  of  the  vascular  circuit  which  is  wounded, 
and  hemorrhage  presents  different  characteristics  according  to  its 
origin  from  capillaries,  veins  or  arteries  respectively: — 

1.  Capillary. — This  is  the  least  dangerous  form ;  it  is  indicated 
by  a  general  oozing  from  the  whole  surface  of  a  wound,  and 
the  color  of  the  blood  is  more  or  less  brick  red. 

2.  Venous. — This  is  indicated  by  the  blood  flowing  in  a  con- 
tinuous  stream,   and   issuing   from   the   cut  end   of  the  vessel 
furthest  from  the  heart,  i.  e.,  in  the  limbs  from  below  the  wound, 
the  color  of  the  blood  being  a  dark  purple.    Venous  hemorrhage 
comes  next  in  seriousness  to  arterial. 

3.  Arterial.— This  is  the  most  serious  form  of  bleeding;  it  is 
indicated  by  the  blood   flowing   in   a   forcible  pulsatile   stream 
(which  rises  with  each  beat  of  the  heart  and  falls  in  the  interval), 
and  issuing  from  the  cut  end  of  the  vessel  nearest  the  heart,  i.  e., 
in  the  limbs  from  above  the  wound,  the  color  of  the  blood  being  a 
bright  scarlet. 

•  The  following  embodies  directions  for  First  Aid  by  the  English  physi- 
cians WARWICK  and  TUNSTALL,  both  acknowledged  authorities  on  the  subject 

175 


176  PASTORAL   MEDICINE. 

External  Hemorrhage. 

1.  THE  TREATMENT  OF  CAPILLARY  HEMORRHAGE. 
— Expose  the  part  to  the  air  and  apply  pressure  to  the  wound  to 
close  the  vessels,  and  prevent  further  escape  of  blood.    This  may 
be  done  by  means  of  a  perfectly  clean  finger,  or  a  clean  bit  of 
sponge  or  lint.     If  the  above  means  are  not  sufficient,  encourage 
coagulation  of  blood,  so  that  the  clot  may  seal  the  cut  vessels ; 
this  may  be  done  by  the  application  of  clean  cold  water,  or  hot 
water  at  a  temperature  of  100°  to  120°  F.,  or  by  first  drying  the 
part  and  then  applying  a  styptic,  such  as  common  salt,  burnt  or 
dried  alum,  tincture  of  steel,  turpentine,   tannic  or  gallic  acid, 
tincture  of  eucalyptus,  etc. 

Note. — Styptics  are  not  to  be  applied  too  strong,  otherwise 
they  destroy  the  vitality  of  the  tissues. 

2.  THE  TREATMENT  OF  VENOUS  HEMORRHAGE.— 
In  treating  bleeding  from  veins,  adopt  the  following  measures, 
viz. : — 

(i,)  Remove  all  constrictions  which  impede  the  backward  flow 
of  blood  to  the  heart,  i.  e.,  all  tight  clothing  about  the  chest  and 
neck  must  be  loosened,  garters  undone,  etc. 

(ii,)  Elevate  the  bleeding  part  if  possible  above  the  level  of 
the  heart,  *.  e.,  if  the  bleeding  is  from  a  limb,  raise  it. 

(iii,)  Apply  first  digital  pressure  (pressure  with  perfectly  clean 
fingers),  directly  to  the  surface  of  the  wound,  and  then  place 
a  clean  pad  on  the  wound  and  keep  it  in  position  by  a  bandage. 

(iv,)  Keep  the  wounded  part  in  an  elevated  position  (if 
possible)  for  some  hours  after  the  bleeding  has  stopped. 

The  Immediate  Treatment  of  a  Burst  Varicose  Vein. — The 
superficial  veins  of  the  lower  extremity  are  liable  to  become 
dilated  or  varicose,  from  the  incompetency  of  their  valves  and 
the  consequent  undue  pressure  of  the  column  of  blood  upon  their 
walls;  these  dilated  veins  may  burst,  producing  serious  or  even 
fatal  hemorrhage  if  not  promptly  attended  to;  the  measures 
therefore  to  be  adopted  in  dealing  with  a  condition  of  this 
description  are  as  follows: — 

(i,)  Place  the  patient  at  once  on  his  back, 
(ii,)  Remove  all  constrictions  round  the  limb  on  the  heart  side. 

(iii,)  Raise  the  wounded  leg. 

(iv,)  Expose  the  bleeding  surface,  place  a  clean  pad  directly 
on  the  wound  and  fix  it,  by  means  of  a  triangular  bandage. 


HEMORRHAGE.  177 

(v,)  If  the  patient  has  to  be  removed,  carry  him  on  a  stretcher, 
lying  on  his  back  with  his  foot  raised. 

(vi,)  Keep  the  patient  in  a  recumbent  position  with  the  foot 
raised  for  some  hours  after  the  accident. 

(vii,)  If  the  bleeding  has  been  at  all  excessive  keep  the  patient 
warm,  in  order  to  counteract  any  sudden  failure  of  the  heart's 
action. 

3.  TREATMENT  OF  ARTERIAL  HEMORRHAGE.— In 
arterial  bleeding  the  force  of  the  heart's  beat  pumping  the  blood 
through  the  cut  vessel  prevents  any  chance  of  clotting,  therefore 
the  two  main  factors  in  stopping  bleeding  are: — 

(i,)  To  place  the  bleeding  part,  if  possible,  in  a  proper  position, 
i.  e.,  above  the  level  of  the  heart,  at  the  same  time  expose  the 
wound  to  the  air,  and  remove  all  constrictions  which  impede  the 
return  of  venous  blood. 

(ii,)  To  apply  pressure  to  the  wound  itself  or  to  the  main 
artery  supplying  the  part.  Pressure  should  always  first  be  applied 
with  the  thumb  and  finger  (digital  pressure),  so  that  no  time  is 
lost  in  getting  appliances. 

To  aid  the  above  means,  the  patient  should  be  kept  absolutely 
quiet  and  in  a  recumbent  position. 

Should  there  be  any  constitutional  symptoms  (syncope),  these 
must  be  treated.  (See  page  178.) 

"FIRST  AID"  METHODS  OF  CONTROLLING  AR- 
TERIAL HEMORRHAGE.— The  measures  to  be  adopted  will 
depend  upon  the  severity  of  the  bleeding. 

1.  IF  THE  BLEEDING  is  NOT  EXCESSIVE,  i.  e.,  in  all  superficial 
hemorrhages  apply: — 

(i,)  Firm  pressure  directly  to  the  bleeding  point  by  means  of 
absolutely  clean  fingers,  and  when  the  bleeding  has  quite  stopped 
place 

(ii,)  A  clean  pad  over  the  wound  and  keep  it  in  position  either 
by  means  of  a  folded  triangular  bandage,  or  by  a  roller  bandage. 

In  some  situations,  e.  g.,  the  palm  of  the  hand,  a  graduated 
compress  (made  by  superimposing  several  layers  of  clean  lint 
upon  each  other,  the  smallest  piece  being  about  the  size  of  a 
quarter  and  the  largest  that  of  a  50  cent  piece)  is  more  effective 
than  a  simple  pad. 

2.  IF  THE  BLEEDING  is  EXCESSIVE,  apply  if  possible:— 

(i,)  Digital  Compression  (compression  by  means  of  the 
fingers)  to  the  main  artery  supplying  the  part  with  blood.  This 


178  PASTORAL   MEDICINE. 

pressure  is  applied  to  the  artery  between  the  wound  and  the 
heart,  and  at  a  joint  where  some  hard  basis  of  support  is  fur- 
nished, against  which  the  artery  can  be  pressed,  e.  g.,  where  the 
vessel  passes  over  or  along  a  bone. 

The  great  value  of  digital  compression  is  that  it  can  be  ap- 
plied immediately.  In  digital  compression  the  following  points 
are  to  be  remembered : — 

(a,)  To  use  the  thumb  to  make  the  pressure. 
(&,)  Having  ascertained  the   position  of  the  artery  by  its 
pulsation,  get  it  fairly  against  the  bone,  and  press  directly 
upon  it,  using  sufficient  force  just  to  stop  the  bleeding 
but  not  to  cause  the  patient  any  pain. 

(c,)  Compress  if  possible  the  artery  only,  avoiding  all  ad- 
jacent structures  such  as  veins  and  nerves.    Digital  com- 
pression is  only  applicable  in  certain  parts  of  the  body, 
viz.,  the  limbs,  the  neck,  and  some  parts  of  the  head  and 
face,  and  it  can  not  be  effectively  maintained  by  one  per- 
son for  more  than  about  fifteen  minutes  at  a  time, 
(ii,)  Replace  Digital  Compression  by  applying  a  hard  pad  upon 
the  artery,  and  keeping  it  in  position  by  a  bandage. 

THE  TREATMENT  OF  CONSTITUTIONAL  SYMP- 
TOMS.— In  order  to  counteract  syncope  or  fainting  due  to  the 
loss  of  blood,  the  patient  must  be  kept  at  absolute  rest  in  a  re- 
cumbent position  with  the  feet  slightly  raised ;  his  clothes  should 
be  removed,  his  body  should  be  wrapped  in  warm  blankets,  and 
hot-water  bottles  should  be  applied  to  his  feet.  If  able  to 
swallow,  stimulants  well  diluted  are  to  be  given  in  small  quan- 
tities, but  only  after  the  hemorrhage  has  entirely  stopped.  If 
the  loss  of  blood  has  been  very  excessive,  the  breathing  may 
become  embarrassed,  or  may  actually  stop;  artificial  respiration 
must  then  be  resorted  to. 

Internal  Hemorrhage. 

The  CAUSES  of  internal  hemorrhage  are: — 

(i,)  Injury  from  blows,  punctured  wounds,  severe  crushes,  and 
falls  causing  bruising  and  laceration  of  internal  organs. 

(ii,)  Disease  producing  bursting  of  a  blood-vessel. 

The  blood  in  internal  hemorrhage  may  either  escape  into  one 
of  the  closed  cavities  of  the  body,  such  as  the  abdomen,  cranium, 
or  thorax,  or  it  may  make  its  escape  externally  through  an 
opening  in  the  body,  artificial  or  natural. 


HEMORRHAGE.  179 

Serious  hemorrhage  into  a  closed  cavity  is  denoted  by  the 
history  of  the  accident  and  the  signs  of  syncope  or  fainting. 

Measures  to  be  adopted  in  a  condition  of  this  description  are : — 

(i,)  To  send  at  once  for  medical  assistance. 

(ii,)  In  the  meanwhile  to  treat  the  constitutional  symptoms 
which  are  due  to  the  loss  of  blood. 

When  the  blood  makes  its  escape  through  one  of  the  natural 
openings  of  the  body,  it  make  take  the  form  of:— 

(i,)  Blood  Spitting;  (2,)  Blood  Vomiting;  (3,)  Nose  Bleeding. 

I.  BLOOD  SPITTING.— This  may  proceed  from:— 

(a,)  The  Mucous  Membrane  of  the  Mouth,  especially  the  gums, 
or  from  the  cavity  left  after  the  extraction  of  a  tooth. 

TREATMENT. — If  the  bleeding  is  slight,  the  patient  must  wash 
his  mouth  out  with  hot  water,  as  hot  as  it  can  be  borne,  or 
with  a  solution  of  alum,  or  with  a  strong  solution  of  salt  and 
water,  or  small  pieces  of  ice  must  be  given  him  to  suck.  If  the 
bleeding  is  from  the  socket  of  a  tooth,  plug  it  well  with  a  pledget 
of  cotton  wool  which  has  been  dipped  in  a  solution  of  salt  and 
water.  If  the  bleeding  is  severe,  apply  pressure  directly  to  the 
bleeding  point  if  possible,  by  means  of  a  small  pad  of  clean  lint. 

(&,)   The  Throat,  caused  by  injury  to  the  wind  pipe  or  gullet. 

TREATMENT. — Keep  the  patient  quiet  in  a  reclining  position, 
and  give  him  small  pieces  of  ice  to  suck  at  frequent  intervals. 

(c,)  The  Posterior  Surface  of  the  Mucous  Membrane  of  the 
Nose. 

TREATMENT.  (See  Bleeding  from  the  Nose.) 

(</,)  From  the  Lungs. — Bleeding  from  the  lungs  is  indicated 
by  scarlet  and  frothy  blood  coughed  up  in  mouthfuls.  It  is  usually 
the  result  of  either  disease  of  the  lungs  or  injury  to  the  ribs. 

TREATMENT. — (i,)  Send  at  once  for  medical  assistance,  in  the 
meanwhile — 

(ii,)  Lay  the  patient  down  on  his  side  with  his  head  and 
shoulders  slightly  raised  on  a  pillow;  keep  him  absolutely  quiet, 
and  prevent  him  from  talking  or  making  the  slightest  exertion. 

(iii,)  Open  the  windows  and  admit  plenty  of  fresh,  cool  air. 

(iv,)  Give  the  patient  ice  to  suck,  or  let  him  sip  cold  water,  or 
vinegar  and  cold  water,  or  a  strong  solution  of  alum  and  water, 
or  strong  cold  tea  with  a  lump  of  ice  in  it. 

(v,)  Remove  all  constrictions  round  the  patient's  chest,  and 
apply  cold  to  it  either  by  means  of  an  ice  bag,  or  a  cloth  which 
has  been  rung  out  in  ice-cold  water. 


i8o  PASTORAL   MEDICINE. 

(vi,)  If  the  faintness  is  severe,  be  cautious  in  the  administration 
of  stimulants. 

(vii,)  Apply  smelling  salts  to  nostrils,  and  warmth  to  the  feet. 

2.  BLOOD  VOMITING.— This  is  usually  caused  by  disease 
affecting  the  walls  of  the  stomach. 

Its  occurrence  is  preceded  by  faintness,  with  a  feeljng  of  weight 
at  the  pit  of  the  stomach,  paleness  in  the  face,  and  a  feeble 
pulse.  The  blood  vomited  up  is  dark  in  color,  sometimes  coagu- 
lated and  mixed  with  food,  and  presents  the  appearance  more 
or  less  of  coffee  grounds. 

TREATMENT. — The  same  as  that  for  bleeding  from  the  lungs. 

3.  BLEEDING  FROM  THE  NOSE.— This  may  be  due  to 
injury  to  the  nose;  it  may  be  an  effort  of  nature  to  relieve  a 
diseased  condition,  and  if  so  it  is  not  to  be  lightly  stopped;  or  it 
may  be  the  result  of  general  constitutional  disturbance. 

TREATMENT. — If  severe,  send  at  once  for  medical  assistance  and 
take  care  that  the  doctor  is  made  acquainted  with  the  nature 
of  the  case;  in  the  meanwhile  undo  all  tight  clothing  round  the 
neck,  make  the  patient  sit  down  on  a  chair  or  sofa,  with  his 
head  slightly  thrown  back  (never  allow  the  patient  to  hang  his 
head  over  a  basin),  open  the  window,  raise  the  arms  stretched  to 
their  full  extent,  well  above  and  behind  the  head,  and  keep  them 
in  that  position,  apply  a  cold  wet  sponge,  or  a  wet  towel,  or  a 
lump  of  ice  to  the  back  of  the  neck  between  the  shoulder  blades, 
also  apply  cold  to  the  root  of  the  nose ;  if  the  bleeding  does  not 
stop,  syringe  out  the  nostril  from  which  the  blood  is  flowing  with 
cold  water,  or  with  a  solution  of  alum  (i  to  2  teaspoonfuls  to  a 
pint  of  water),  or  with  cold  tea.  Pinch  the  nose  just  below  the 
bridge  between  the  thumb  and  forefinger,  or  take  a  piece  of  soft 
rag,  wrap  it  up  tightly  and  pass  it  gently  into  the  bleeding 
nostril. 

II. WOUNDS  AND  THEIR  IMMEDIATE 

TREATMENT. 

DEFINITION.— Wounds  may  be  denned  as  injuries  to  the 
body  with  division  of  the  skin  and  of  the  underlying  parts,  more 
or  less. 

Wounds  are  of  two  kinds : — I.  Simple;  II.  Poisoned. 

I.— SIMPLE  WOUNDS  present  the  following  varieties  :— 

(a)     Incised  or   Clean  Cut   Wounds. — Wounds   with   cleanly 


WOUNDS.  181 

divided  edges  and  more  or  less  free  bleeding,  produced  by  sharp 
edged  instruments. 

(6,)  Contused  or  Bruised  Wounds.— Wounds  with  bruising 
of  the  parts  and  only  slight  or  no  external  bleeding,  produced 
by  blunt  instruments. 

(c,)  Punctured  or  Stab  Wounds.— Wounds  with,  as  a  rule, 
considerable  bleeding  and  deep  internal  injuries,  produced  by 
shart  pointed  instruments. 

(d,)  Lacerated  Wounds.— Wounds  with  ragged  edges  and  very 
little  bleeding,  caused  by  tears,  as  from  machinery  in  motion, 
the  bites  of  animals,  etc. 

Bullet  wounds  generally  combine  the  characters  of  punctured 
and  lacerated  wounds,  with,  in  some  cases,  injury  to  the  bone. 

THE  IMMEDIATE  TREATMENT  OF  WOUNDS  IN  GENERAL. 

Here  the  following  points  are  to  be  borne  in  mind : — 
(i,)  To  arrest  the  bleeding. 

(ii,)  To  cleanse  the  wound. 

(iii,)  To  keep  the  wounded  parts,  if  possible,  at  rest  by  the 
application  of  slings  or  splints. 

(iv,)  To  protect  the  wound  from  outside  dust  and  dirt  by 
means  of  some  antiseptic  (clean)  dressing  material. 

(v,)  To  treat  constitutional  symptoms,  if  any,  such  as  shock. 

Therefore,  when  a  wound  has  been  inflicted,  the  first  thing  to 
do  is  to  avoid  touching  it  with  dirty  hands  or  dirty  instruments; 
there  is  no  justification  for  introducing  more  dirt  into  the  wound 
that  may  be  already  dirty. 

After  arresting  the  bleeding  proceed  as  follows : — 

If  no  means  are  ready  available  to  render  the  hands  and  the 
wound  clean,  either  leave  the  wound  alone  or  cover  it  up  with 
some  antiseptic  dressing,  if  one  can  be  got  at  once,  till  means 
are  at  hand  to  cleanse  the  wound. 

TO  CLEANSE  THE  WOUND  do  not  attempt  to  wash  it  with 
water  procured  from  any  source.  Before  handling  the  wound 
with  the  fingers  wash  the  hands  first  with  warm  water  and 
soap,  and  then  rub  them  with  turpentine  or  rinse  them  in 
carbolic  solution  I  in  40,  then  wash  the  wound  thoroughly  with 
an  antiseptic  solution,  such  as  carbolic  acid  i  in  20  to  I  in  40, 
or  perchloride  of  mercury  I  in  1000  to  i  in  2000. 


1 82  PASTORAL   MEDICINE. 

If  the  above  solutions  are  not  at  hand  or  can  not  be  easily 
procured,  any  of  the  following  may  be  used: — 

Alcohol,  in  the  form  of  whisky  or  methylated  spirits,  with  an 
equal  bulk  of  water  which  has  been  first  well  boiled  and  then 
allowed  to  cool. 

Common  Salt,  a  dessertspoonful  dissolved  in  a  tumbler  of 
warm  water. 

In  washing  the  wound  be  careful  not  to  detach  any  blood 
clots  which  may  have  formed  in  it,  as  they  prevent  further 
bleeding  and  exclude  impurities. 

After  the  wound  has  been  well  cleansed  of  all  dirt,  in  order  to 
keep  it  clean  take  a  pledget  of  cotton  wool,  soak  it  well  in  the 
antiseptic  solution  which  has  been  used  to  wash  the  wound, 
squeeze  it  dry  and  place  it  over  the  wound  as  a  temporary 
protection. 

TO  DRESS  THE  WOUND  proceed  as  follows:— If  ready- 
made  antiseptic  surgical  dressings  are  at  hand  use  them,  if  not, 
place  on  the  wound  either — 

A  piece  of  clean  linen  which  has  been  well  boiled  for  five 
minutes  and  then  wrung  out,  or  a  piece  of  lint  soaked  in 
carbolic  solution  I  in  40,  carbolic  oil  I  in  10. 

Over  this  apply  a  few  layers  of  clean  cotton  wool,  and  then  a 
bandage  to  keep  the  dressing  in  position. 

TO  KEEP  THE  PARTS  AT  REST.— First  place  the  edges 
as  near  together  as  possible  by  strapping,  and  then,  should  the 
wound  be  in  the  upper  extremity,  put  the  forearm  in  a  large 
arm  sling;  if  the  wound  happens  to  be  near  a  joint,  apply  a  splint 
and  then  put  on  the  sling;  if  the  lower  extremity  is  wounded 
apply  an  outside  splint  to  the  limb.  Should  the  wound  be  in  the 
abdomen  or  chest,  bandage  firmly. 

SPECIAL  POINTS  IN  THE  IMMEDIATE  TREATMENT  OF — 

i.  INCISED  WOUNDS.— Arrest  the  bleeding:  then,  if 
necessary,  wash  and  dress  the  wound  as  indicated  above;  if  the 
edges  of  the  wound  gape,  adjust  them  by  means  of  strapping, 
taking  care  not  to  completely  cover  the  wound ;  the  strapping  is 
best  applied  thus — two  strips  of  strapping  long  enough  to  reach 
well  beyond  the  edges  of  the  wound  are  taken,  in  the  centre 
of  one  piece  a  longitudinal  slit  is  cut,  the  edges  out  of  the 
centre  of  the  other  piece  are  cut  away,  so  that  this  piece  can 


WOUNDS.  183 

fit  into  the  longitudinal  slit,  one  piece  is  now  placed  on  one 
side  of  the  wound,  the  other  piece  on  the  other  side,  the  middle 
parts  are  slipped  one  into  the  other  and  an  even  pull  is  made 
simultaneously  on  both. 

2.  CONTUSED  WOUNDS.-Apply  pressure  to  the  part  by 
means  of  a  pad  of  cotton  wool  or  linen  dipped  in  one  of  the  anti- 
septic solutions  enumerated  above  if  the  skin  is  broken,  and  fix 
the  pad  by  a  narrow  folded  triangular  bandage,  or  a  figure  of 
8  roller  bandage;   should  the  skin  not  be  broken,  apply  to  the 
part  a  piece  of  lint  which  has  been  soaked  in  a  lotion  consisting 
of  spirits  of  wine  one-third  and  water  two-thirds ;  and  moisten  it 
often. 

3.  PUNCTURED  WOUNDS.— Arrest  the  bleeding  and  wash 
and  dress  the  wound. 

4.  LACERATED   WOUNDS.— Wash  and  dress  the  wound. 
Shock  usually  supervenes  after  severe  lacerations,  therefore  if 
present,  treat  it. 

II.— POISONED  WOUNDS. 

These  may  be — 

(a,)  The  True  Poisoned  Wound. — Produced  by  the  introduc- 
tion of  decomposing  animal  matter  or  other  dirt  under  the 
skin. 

TREATMENT. — Wash  the  part  immediately  with  a  strong  dis- 
infectant. 

(&,)  Stings  of  Insects. 

TREATMENT. — Extract  the  sting  by  pressing  a  small  key  (a 
watch  key  is  the  best)  on  to  the  wounded  part,  wash  the  wound 
with  a  solution  of  ammonia,  soda  or  potash,  or  with  an  antiseptic 
solution. 

A  certain  amount  of  shock  may  sometimes  supervene;  if  so, 
give  stimulants. 

(c,)  Snake  Bites. 

TREATMENT. — Send  for  medical  assistance,  but  in  the  mean- 
while apply  a  ligature  or  an  improvised  tourniquet  on  the  limb 
between  the  wound  and  the  heart,  to  prevent  the  general  absorp- 
tion of  the  poison  into  the  system ;  bathe  the  wounded  part 
first  with  warm  water  to  encourage  bleeding,  then  with  strong 
antiseptic  solutions,  then  cauterize  the  wound  with  a  red  hot 
iron,  or  nitrate  of  silver.  To  extract  the  poison,  sucking  the 
wound  may  be  resorted  to,  but  the  operator  should  see  that  he 
has  no  cuts  or  fissures  about  his  lips  or  tongue.  Treat  shock  if 


184  PASTORAL   MEDICINE. 

present  by  administering  stimulants  freely,  and  artificial  respira- 
tion may  have  to  be  resorted  to. 

(</,)  Bites  by  Mad  Dogs. — Adopt  treatment  the  same  as  that 
for  Snake  bites. 


III. — SPRAINS,    DISLOCATIONS,    FRACTURES,   AND 
THEIR    IMMEDIATE    TREATMENT. 

Sprains. 

DEFINITION. — A  sprain  is  the  straining  or  tearing  of  the 
ligaments  and  capsule  which  surround  a  joint,  by  a  sudden  twist 
or  wrench — a  sprain  is  practically  a  "  missed  dislocation." 

CAUSES: — Falls  on  to,  or  some  sudden  and  unnatural  move- 
ment of,  a  joint. 

SIGNS: — Pain,  heat,  and  swelling  at  the  seat  of  the  injury, 
followed  subsequently  by  discoloration  of  the  skin. 

TREATMENT. — Put  the  parts  at  complete  rest ;  if  the  sprain  is 
in  a  joint  of  the  upper  extremity,  apply  a  padded  splint  to  the 
inside  of  the  limb,  and  then  place  the  forearm  in  a  large  arm 
sling ;  if  in  a  joint  of  the  lower  extremity,  place  the  patient  in 
bed,  apply  a  padded  back  splint  to  the  limb  and  keep  it  slightly 
elevated.  After  the  limb  has  been  put  at  rest,  apply  bandages 
dipped  in  cold  water,  or  an  ice  bag,  to  the  injured  joint;  if  the 
pain  is  severe  and  cold  applications  can  not  be  tolerated,  bathe 
the  joint  with  water  as  hot  as  it  can  be  borne  comfortably,  or 
apply  hot  bran  poultices  to  it. 

Dislocations. 

DEFINITION. — A  dislocation  is  the  displacement  of  a  bone 
at  a  joint. 

CAUSES: — The  same  as  those  of  a  sprain,  but  applied  more 
violently. 

SIGNS:— (o,)  Distortion  of  the  joint. 

(&,)  The   end  of  the   displaced   bone   may  be   felt 

through  the  skin. 

(c,)  Alteration  in  the  length  of  the  limb, 
(d,)  Loss  of  movement  at  the  joint. 
(e,)  Pain  in  the  joint  increased  on  movement. 


• 
'SPRAINS,  DISLOCATIONS,  ETC.          185 

(f,)  The  limb  is  fixed  when  another  tries  to  move  it 
(thus  distinguishing  it  from  fracture  near  a 
joint). 

TREATMENT.— Make  no  attempt  to  reduce  the  dislocation;  put 
the  parts  at  complete  rest  to  relieve  pain,  place  the  patient  in  an 
easy  position  and  send  for  medical  assistance. 

Fractures. 

DEFINITION.— A  fracture  is  a  broken  bone. 
Causes : — 

1.  Direct  violence,  by  means  of  which  the  bone  is  broken  at 
the  seat  of  the  injury. 

2.  Indirect  violence,  by  means  of  which  the  bone  is  broken  at 
some  distance  from  the  seat  of  the  injury  by  transmission  of 
the  force  applied,  e.  g.,  fracture  of  the  collar  bone  by  a  fall  upon 
the  outstretched  hand;  fracture  of  the  base  of  the  skull  by  a 
fall  from  a  height  upon  the  feet. 

3.  Muscular  action — snapping  the  bone  across  by  a  sudden  and 
violent  contraction,  e.  g.,  the  knee-cap  in  jumping. 

VARIETIES  OF  FRACTURES.    These  are:— 

I. — Simple. — Where  the  bone  only  is  broken. 

II. — Compound. — Where  the  bone  is  broken  and  there  is  an 
external  wound  communicating  with  the  break. 

Fractures  may  be : — 

(i,)  Comminuted. — Where  the  bone  is  splintered  into  several 
fragments. 

(ii,)  Complicated. — Where  the  fracture  is  complicated  by  an 
injury  to  some  important  surrounding  parts,  e.  g.,  the  tearing  of 
an  artery,  vein  or  nerve;  the  opening  up  of  a  joint;  the  wounding 
of  an  internal  organ,  as  the  lung,  bladder,  etc. 

(iii,)  Impacted. — Where  the  bones  are  broken  and  the  ends 
are  wedged  into  one  another. 

(iv,)  Greenstick. — Where  the  bone  is  incompletely  broken  or 
bent — usually  met  with  in  children. 

REPAIR  OF  FRACTURES.— Fractures  are  repaired  by  the 
space  between  the  broken  ends  of  the  bone  and  the  torn  periosteum 
being  filled  up  by  a  soft  mass  of  new  material — termed  callus, 
which  unites  the  broken  ends  together;  in  course  of  time  this 
soft  material  is  converted  into  fibrous  tissue,  then  lime  salts  are 
deposited  in  it  and  it  is  gradually  formed  into  bone;  the  new 
bone  can  at  first  be  felt  as  a  thickened  mass  round  the  fracture, 


1 86  PASTORAL   MEDICINE. 

but  gradually  it  becomes  entirely  absorbed.  Should  the  broken 
ends  of  a  bone  not  be  kept  at  complete  rest  bony  union  never 
results,  the  callus  remains  fibrous  and  there  is  produced  what  is 
termed  a  false  joint. 

SIGNS  OF  FRACTURE.— These  are:— 

(a,)   Pain,  swelling,  and  deformity  at  the  seat  of  the  injury. 

(b,)  Unnatural  mobility  where  none  should  exist. 

(c,)  Loss  of  power  in  the  limb. 

(d,)   Shortening  of  the  limb. 

(e,)  Crepitus,  i.  e.,  a  sensation  of  grating  felt  when  the  broken 
ends  of  the  bones  are  made  to  move  against  each  other. 

TREATMENT. — In  the  immediate  treatment  of  a  fracture  the 
following  points  have  to  be  borne  in  mind: — The  Prevention  of 
Further  Injury.  The  Proper  Transport  of  the  Injured  Person. 

THE  PREVENTION  OF  FURTHER  INJURY.— For  this 
adopt  the  following  measures  viz. : — 

1,  Attend  to   the  patient  on  the   spot  where  the   injury  has 
occurred,  and  especially  so  if  the  fracture  happens  to  be  in  the 
lower  extremity. 

2,  Don't  touch  the  limb   (beyond  what  is  absolutely  necessary 
for  diagnosis),  until  you  have  got  all  splints  and  bandages  ready. 

3,  Use   extreme   care    and    gentleness    in   handling   the   limb, 
either  for  the  purpose  of  trying  to  make  out  the  fracture  (*'.  e., 
trying   for  crepitus,   etc.),   or   in   putting  on   splints:    by   rough 
handling    a    simple    fracture    may    very    easily   be    made    into    a 
compound  or  complicated  one.    This  precaution  is  to  be  especially 
borne  in  mind  in  handling  broken  bones  which  are  immediately 
under  the  skin,  such  as  the  collar  bone  (clavicle),  and  the  shin 
bone  (tibia). 

4,  Without  removing  the  clothes  (unless  the  fracture  is  com- 
pound or  there  is  hemorrhage),  bring  the  bones  into  their  relative 
position  as  follows :  First  lift  the  limb  by  grasping  it  very  gently 
but  firmly  above  and  below  the  seat  of  the  fracture,  and  then 
make  gentle  extension   and  counter-extension  to  restore  to  its 
natural  position  as  far  as  possible. 

5,  Fix  the  limb  in  this  position  by  means  of  splints  and  band- 
ages. 

THE  PROPER  TRANSPORT  OF  THE  INJURED 
PERSON. — It  is  important  to  bear  in  mind  that  a  person  suffer- 
ing from  a  fracture  is  not  to  be  removed  till  the  broken  bone  has 
been  first  put  up.  If  able  to  walk,  he  should  not  be  permitted  to 


ARTIFICIAL  RESPIRATION.  187 

leave  the  spot  unassisted,  as  faintness,  giddiness,  or  even  uncon- 
sciousness may  come  on  some  time  after  the  fracture  has  occurred ; 
most  persons  suffering  from  fractures  of  the  upper  limb  can  walk 
if  assisted.  Those  suffering  from  fractures  of  the  lower  limb 
should  always  be  carried  on  a  stretcher. 


THE  IMMEDIATE  TREATMENT  OF  A  COMPOUND  FRACTURE. 

Here  proceed  as  follows : — 

Remove  the  clothing,  if  required,  from  the  injured  part  with 
extreme  care.  If  there  is  hemorrhage,  arrest  it  either  by  elevat- 
ing the  limb,  or  applying  pressure  to  the  main  artery,  above  the 
wound.  If  transport  is  readily  available,  and  skilled  help  can  be 
quickly  obtained,  cover  the  wound  temporarily  with  an  antiseptic 
(clean)  pad  to  prevent  the  entrance  of  impurities,  apply  splints 
as  far  as  practicable  in  the  manner  indicated  above  and  remove 
the  patient  from  the  scene  of  the  accident.  If  skilled  help  can 
not  be  speedily  procured,  thoroughly  cleanse  the  wound  with  an 
antiseptic  solution,  adopting  all  the  precautions  laid  down  in 
Chapter  II;  apply  an  antiseptic  dressing  to  the  wound,  then 
put  on  the  splints  and  remove  the  patient 


IV. — ARTIFICIAL    RESPIRATION    AND   THE 
TREATMENT   OF   ASPHYXIA. 

Artificial  Respiration. 

VARIOUS  methods  have  been  proposed  for  performing  artificial 
respiration.    Those  most  usually  adopted  are:— 

1,  Dr.  Sylvester's  Method. 

2,  Dr.  Benjamin  Howard's  "Direct  Method." 

3,  Dr.  Marshall  Hall's  "  Ready  Method." 

i.    THE    SYLVESTER   METHOD.— This   method  has  the 
following  points  to  recommend  it: — 
(i,)  It  is  simple. 

(ii,)  It  is  effective. 

(in,)  It  is  to  a  great  extent  in  harmony  with  the  process  of 
natural  respiration. 


i88  PASTORAL   MEDICINE. 

(iv,)  The  expansion  of  the  thorax  is  artificially  insured,  and 
the  method  is  wholly  under  the  control  of  the  operator. 

(v,)  The  patient  is  not  liable  to  be  injured  by  the  manipula- 
tions. 

(vi,)  Both  sides  of  the  chest  are  equally  inflated  and  a  large 
amount  of  air  is  inspired. 

(vii,)  The  adoption  of  the  method  is  easy.  It  can  be  remem- 
bered and  it  can  be  efficiently  put  into  operation  by  one  person. 

Mode  of  Procedure. — Lay  the  patient  flat  on  his  back  on  the 
floor,  loosen  all  tight  clothing  about  the  neck,  chest,  and  abdomen, 
and  loosen  the  braces;  place  a  block  or  hard  pillow  under  the 
patient's  shoulders  (in  order  to  raise  the  chest,  extend  the  neck 
and  throw  the  head  back),  draw  forward  the  tongue  and  get  an 
assistant  to  hold  it  in  the  corner  of  a  handkerchief  between  the 
thumb  and  finger;  if  unassisted,  fasten  the  tongue  round  the 
chin  by  an  indiarubber  band  or  a  piece  of  string. 

Now  kneel  at  the  patient's  head;  take  hold  of  his  arms  above 
the  elbows  and  carry  them  well  over  the  head  as  far  back  as  they 
will  go,  this  will  have  the  effect  of  expanding  the  chest.  Hold 
the  arms  in  this  position  for  two  seconds,  then  bring  them 
down  against  the  ribs,  cross  the  forearms  over  the  pit  of  the 
stomach,  and,  kneeling  well  forward,  make  steady  pressure  upon 
the  sides  and  front  of  the  chest;  keep  up  this  pressure  for  two 
seconds.  This  will  have  the  effect  of  expelling  the  air  from  the 
chest. 

Repeat  the  above  movements  carefully  and  deliberately  about 
fifteen  times  a  minute  till  the  natural  respiration  becomes  estab- 
lished. This  will  be  indicated  by  the  patient  beginning  to  take 
short  gasps.  Then  cease  the  movements,  but  watch  the  patient 
carefully  for  some  time,  as  the  respiration,  after  being  once 
established,  is  again  liable  to  fail  and  may  have  to  be  restored. 

If  the  expansion  and  the  compression  of  the  chest  are  efficiently 
performed,  the  flow  of  air  in  and  out  of  the  larynx  can  be  dis- 
tinctly heard. 

2.  DR.  BENJAMIN  HOWARD'S  "DIRECT  METHOD."— 
This  method  has  the  advantage  that  it  can  be  used  in  cases  where 
there  is  injury  to  the  arms. 

It  is  more  vigorous  than  the  "  Sylvester  method,"  and  it  is 
easily  put  into  practice,  but  it  has  the  disadvantage  that,  if 
forcible  pressure  is  used  by  an  unskilled  operator,  the  patient 
runs  the  risk  of  being  injured  during  its  performance. 


ARTIFICIAL  RESPIRATION.  189 

Mode  of  Procedure.— Lay  the  patient  flat  on  his  back,  put  a 
hard  pillow  or  roll  of  clothing  (larger  than  that  used  in  the 
"  Sylvester  method ")  well  under  the  back  in  order  that  the 
lower  part  of  the  chest  may  be  the  highest,  place  the  patient's 
forearms  crossed  on  the  top  of  the  forehead,  and  strip  the 
clothing  from  the  waist  and  neck. 

Now  kneel  astride  the  patient's  hips,  facing  his  head,  place 
the  hands,  with  the  fingers  spread  well  apart,  on  the  most  com- 
pressible part  of  the  lower  ribs,  taking  care  that  the  thumbs  do 
not  press  upon  the  pit  of  the  stomach,  and  squeeze  together  the 
two  sides  of  the  patient's  chest  at  the  same  time,  leaning 
gradually  forward  till  the  whole  weight  is  over  the  patient  and 
the  mouth  is  nearly  touching  that  of  the  patient's;  remain  in 
this  position  for  two  seconds,  then  spring  back  to  the  kneeling 
position,  lifting  the  hands  off  the  patient's  sides. 

Continue  these  movements  at  the  rate  of  about  fifteen  a 
minute  till  the  respiration  becomes  established. 

3,  DR.  MARSHALL  HALL'S  "READY  METHOD."— This 
is  the  least  efficient  of  the  three  methods,  as  only  one  side  of  the 
chest  is  compressed,  and  expansion  of  the  lung  can  only  take 
place  on  the  non-compressed  side. 

It  is  also  the  mildest,  it  requires  considerable  practice  before 
one  can  be  efficient  in  it,  and  it  needs  three  persons  to  perform  it. 

Mode  of  Procedure. — Take  up  a  position  on  the  left  side  of 
the  patient,  make  one  assistant  kneel  at  the  patient's  head  and 
another  assistant  at  the  patient's  feet,  place  a  hard  roll  of 
clothing  (which  must  be  twice  as  long  as  that  used  in  Howard's 
method)  in  such  a  manner  that  when  the  patient  is  turned  over 
his  chest  will  be  across  the  roll. 

Now  with  the  help  of  the  two  assistants  turn  the  patient  face 
downward,  making  the  body  incline  over  the  roll  of  clothing, 
and  make  firm  pressure  with  the  hand  upon  the  back,  between 
and  on  the  shoulder  blades,  then  turn  the  body  on  the  side 
again.  In  turning  the  patient  the  assistant  at  the  head  must 
see  that  the  patient's  arms  are  not  laid  upon  or  twisted. 

Repeat  these  movements  and  continue  them  at  the  rate  of 
fifteen  a  minute  till  respiration  becomes  established. 


190  PASTORAL   MEDICINE. 


Asphyxia  and  its  Treatment. 

DEFINITION. — By  asphyxia  is  meant  the  condition  which 
supervenes  when  the  function  of  respiration  has  been  inter- 
rupted. Death  from  asphyxia  is  due  to  carbonic  acid  poisoning. 

Asphyxia  may  be  caused  by: — 

(i,)  Submersion  in  a  liquid  medium,  as  in  drowning. 

(ii,)  Occlusion  of  the  air  passages  by  foreign  bodies,  as  in 
choking. 

(iii,)  Pressure  on  the  chest,  preventing  the  action  of  the 
respiratory  muscles. 

(iv,)  Closure  of  the  air  passages,  as  in  suffocation  or  smother- 
ing. 

(v,)  External  pressure  on  the  air  passages,  as  in  strangulation 
or  hanging. 

(vi,)  Breathing  irrespirable  gases,  such  as  nitrogen,  hydrogen, 
carbonic  oxide,  sulphuretted  hydrogen,  chlorine,  chloroform 
vapor,  etc. 

THE  TREATMENT  OF  ASPHYXIA. — For  some  minutes  (about 
four)  after  the  respirations  have  entirely  stopped  the  heart's 
action  continues,  and  as  long  as  the  heart  beats  recovery  from 
asphyxia  is  possible. 

The  main  indications  for  treatment  are: — 

(i,)  To  remove  as  quickly  as  possible  the  cause  of  the 
asphyxia. 

(ii,)  To  effect  the  purification  of  the  blood  by  introducing 
fresh  air  into  the  lungs  by  means  of  artificial  respiration  or 
otherwise. 

THE  TREATMENT  OF  APPARENT  DEATH  FROM 
DROWNING. — The  appearances  presented  by  a  person  who  has 
been  immersed  for  some  time  in  the  water  are  as  follows : — 

The  face  is  swollen  and  purple,  the  lips  are  livid,  the  eyes  are 
blood-shot,  the  mouth,  wind-pipe  and  lungs  contain  frothy  fluid, 
there  is  a  considerable  quantity  of  water  in  the  stomach,  the  feet 
and  hands  may  be  swollen  and  discolored,  and  the  body  is  cold. 

In  treating  the  apparently  drowned  the  following  factors  have 
to  be  borne  in  mind : — 

(i,)  The  condition  of  asphyxia  due  chiefly  to   submersion, 
but  also  to  the  blocking  of  the  air  passages  with  water,  mud,  etc. 

(ii,)  The  shock  to  the  system. 


ASPHYXIA.  191 

(Hi,)  The  exhaustion  from  long-continued  struggling. 

(iv,)  The  effect  of  exposure  to  the  cold. 

The  most  important  factor,  however,  in  treatment  is  to  remove 
the  condition  of  asphyxia  as  soon  as  possible  by  artificial  res- 
piration. 

DIRECTIONS  FOR  RESTORING  THE  APPARENTLY 
DROWNED  :— 

(i,)  Send  at  once  for  medical  assistance,  blankets  and  dry 
clothing,  in  the  meanwhile — 

(ii,)  Immediately  proceed  to  treat  the  patient  on  the  spot,  by 
first  restoring  the  breathing,  and,  after  the  breathing  has  been 
restored,  by  promoting  warmth  and  circulation.  It  is  important 
not  to  attempt  to  restore  the  circulation  till  the  breathing  has 
recommenced,  as  by  over-taxing  an  already  dilated  heart,  life  is 
endangered. 

TO  RESTORE  NATURAL  BREATHING,  proceed  as 
follows : — 

(a.)  Clear  the  Air  Passages. — To  effect  this,  first  remove  all 
tight  clothing  constricting  the  neck  and  chest,  then  turn  the 
patient  face  downward,  placing  a  firm  roll  of  clothing  under  his 
stomach  and  chest,  and  one  of  his  arms  under  the  forehead  so  as 
to  raise  the  mouth  off  the  ground,  now  press  firmly  two  or  three 
times,  for  four  or  five  seconds  each  time,  upon  the  patient's  back, 
this  will  have  the  effect  of  draining  off  water  from  the  lungs 
and  stomach. 

(&,)  Adjust  the  Patient's  Position,  by  turning  him  on  to  his 
back  with  the  roll  of  clothing  under  his  shoulder  blades,  and 
allowing  the  head  to  fall  back. 

(O  Maintain  a  free  entrance  of  air  into  the  Wind  Pipe. — To 
do  this  examine  the  mouth  and  remove  from  it  all  weeds,  mud, 
lumps  of  food,  etc. ;  draw  forward  the  patient's  tongue  and  keep 
it  projecting  beyond  the  lips  by  an  elastic  band  or  a  piece  of  tape 
or  string  passed  over  it  and  under  the  chin;  look  to  the  nostrils 
and  free  them  from  any  obstructions. 

(d,)  Imitate  the  Movements  of  Breathing,  i.  e.,  perform 
"Sylvester's  Method"  of  Artificial  Respiration  (See  page  195), 
and  continue  it  till  the  patient  makes  an  effort  to  breathe. 

(e,)  Encourage  Breathing.— If  any  assistants  are  at  hand 
during  the  performance  of  artificial  respiration,  get  them  to 
excite  the  nostrils  with  snuff  or  smelling  salts,  or  to  tickle  the 
throat  with  a  feather,  also  to  rub  the  face  and  chest  briskly. 


192  PASTORAL   MEDICINE. 

While  artificial  respiration  is  being  performed,  make  those 
who  are  assisting  dry  the  patient's  hands  and  feet,  and  (if  warm 
clothing  has  been  procured),  to  strip  off  the  wet  clothes  and  re- 
place them  with  dry  ones,  but  in  doing  this,  the  efforts  to  restore 
respiration  must  not  be  hindered.  As  soon  as  breathing  has  com- 
menced proceed  to  promote  warmth  and  circulation.  To  do  this, 
wrap  the  patient  up  in  dry  blankets  and  commence  rubbing  the 
limbs  upward,  firmly  and  energetically,  with  warm  flannels  or 
cloths,  either  under  the  blankets  or  over  the  dry  clothing. 
Apply  hot  flannels,  hot  water  bottles,  hot  bricks,  etc.,  to  the 
pit  of  the  stomach,  to  the  armpits,  between  the  thighs,  and  to 
the  soles  of  the  feet. 

When  the  patient  is  able  to  swallow,  give  him  small  quantities 
of  wine,  warm  brandy  and  water,  or  hot  coffee. 

Put  the  patient  to  bed  and  encourage  sleep.  During  the  period 
of  reaction  the  breathing  may  become  oppressed.  To  obviate 
this,  apply  large  linseed  meal  and  mustard  poultices  to  the  chest 
and  back.  Watch  the  patient  carefully  for  some  time  to  see  that 
the  breathing  does  not  again  fail ;  if  any  signs  of  failure  appear, 
resume  artificial  respiration. 

Note. — The  above  efforts  to  restore  life  must  be  persevered  in 
until  the  arrival  of  medical  assistance  or  until  the  pulse  and 
breathing  have  ceased  for  at  least  an  hour. 

CAUTIONS. — The  following  are  to  be  borne  in  mind: — 

(i,)  Avoid  delay  in  the  application  of  measures  to  restore  life. 

(ii,)  Do  not  waste  much  time  in  the  preliminary  operations, 
*'.  e.,  in  clearing  the  air  passages,  adjusting  the  patient's  position, 
and  maintaining  a  free  entrance  of  air  into  the  wind  pipe,  but 
proceed  to  perform  artificial  respiration  as  quickly  as  possible. 

(iii),  Prevent  crowding  round  the  patient,  especially  if  in  an 
apartment. 

(iv,)  Avoid  rough  usage,  and  do  not  allow  the  body  to  remain 
on  the  back  unless  the  tongue  is  secured. 

(v,)  Avoid  attempts  to  give  stimulants  till  the  patient  is  well 
able  to  swallow. 

(vi),  In  performing  artificial  respiration  avoid  hurried  and 
irregular  motions. 

(ii,)  Avoid  an  overheated  room. 

(viii,)  Under  no  circumstances  hold  the  body  up  by  the  feet. 

(ix,)  On  no  account  place  the  patient  in  a  warm  bath  unless 
under  medical  observation. 


ASPHYXIA.  193 

(.x,)  Avoid  giving  up  hope  for  the  patient  too  soon. 

ASPHYXIA  FROM  CHOKING.— Choking  is  caused  by  bits 
of  food,  foreign  bodies,  etc.,  accidentally  passing  into  the  larynx. 

TREATMENT. — Send  at  once  for  medical  assistance,  but  in  the 
meanwhile  make  attempts  to  dislodge  the  obstruction  by  first 
placing  the  patient  in  the  recumbent  position  with  the  head  turned 
on  one  side,  and  then  passing  the  finger  or  the  handle  of  a  spoon 
over  the  base  of  the  tongue,  and  clawing  forward  with  it.  If  the 
patient  happens  to  be  a  child,  it  may  be  held  up  by  the  feet  and 
slapped  on  the  back.  If,  after  the  foreign  body  has  been  ex- 
tracted, there  are  no  signs  of  breathing,  begin  artificial  respiration 
at  once  and  continue  it  for  at  least  an  hour. 

ASPHYXIA  FROM  BLOCKING  OF  THE  LARYNX, 
CAUSED  BY  SWELLING  OF  THE  MUCOUS  MEMBRANE. 
— Suffocation  in  children  is  often  caused  by  attempting  to  drink 
from  the  spout  of  a  kettle  containing  boiling  water. 

TREATMENT. — Send  at  once  for  medical  assistance,  but  in  the 
meanwhile  wrap  the  child  in  a  blanket,  apply  hot  sponges,  hot 
flannels  (dry  or  moist)  to  the  mouth;  administer,  in  dessert- 
spoonful doses,  salad,  linseed,  or  cod-liver  oil,  and  also  give 
pieces  of  ice  to  suck. 

ASPHYXIA  FROM  ATTEMPTED  HANGING  OR 
STRANGULATION. 

TREATMENT.— Release  the  patient  at  once,  loosen  or  cut  any 
cords  which  may  be  round  his  neck,  also  all  tight  clothing ;  allow 
a  free  current  of  air  to  pass  over  his  face,  dash  cold  water  on 
his  face  and  chest,  and  perform  artificial  respiration. 

ASPHYXIA  FROM  BREATHING  IRRESPIRABLE  AND 
POISONOUS  GASES.— These  gases  include  the  vapors  from 
charcoal,  coal  and  coke,  lime,  brick  and  cement  kilns,  coal  gas, 
the  foul  air  from  sewers,  cesspools  and  mines  (choke  damp), 
the  vapor  of  chloroform,  etc. 

TREATMENT.— Remove  the  patient  at  once  from  the  foul  into 
fresh  air,  loosen  all  tight  clothing,  commence  artificial  respira- 
tion after  drawing  the  tongue  forward  and  securing  it,  at  the 
same  time  apply  friction  and  warmth  to  the  body,  and  dash  cold 
water  upon  the  head  and  face. 

THE  APPEARANCES  WHICH  GENERALLY  ACCOM- 
PANY DEATH  ARE  AS  FOLLOWS:— 

I,  The  breathing  is  absent,  there  is  no  movement  of  the  chest, 
no  'air  can  be  heard  passing  in  and  out  of  it,  and  there  is  no 


i94  PASTORAL   MEDICINE. 

watery  vapor  proceeding  from  the  moHth.  To  determine  the 
presence  of  respiration  place  a  glass  of  water  on  the  chest  and 
watch  if  any  movement  is  communicated  to  it;  also  hold  a 
looking-glass  or  some  bright  surface  to  the  mouth  and  see  if  the 
surface  becomes  dimmed  by  vapor  condensing  upon  it. 

2,  The  heart's  action  has  stopped,  there  is  no  pulse,  the  move- 
ments and  sounds  of  the  heart  have  ceased. 

To  determine  this,  tie  a  ligature  tightly  round  a  finger.  If 
there  is  any  circulation  the  end  of  the  finger  will  become  reddened 
and  the  string  will  leave  a  white  ring  round  the  finger. 

3,  The  eyelids  are   generally  half  closed  and   the  pupils   are 
dilated. 

4,  The  coldness  and  pallor  of  the  surface  of  the  body  increase. 


V. POISONS  AND  THEIR  IMMEDIATE 

TREATMENT. 

DEFINITION.— Poisons  may  be  defined  as  substances  which 
(when  introduced  into  the  body  or  applied  externally)  injure 
health  or  destroy  life. 

CLASSIFICATION. — Poisons  may  be  classed  as  follows: — 

1.  CORROSIVES.— These  soften  and  destroy  the  parts  with 
which  they  come  in  immediate  contact.    As  examples  of  corrosive 
poisons    may    be    mentioned — the    mineral    acids,    the    caustic 
alkalies,    corrosive   sublimate,    the   acid,    alkaline   and   corrosive 
salts  (chlorates  of  zinc,  tin  and  antimony,  nitrate  of  silver,  sul- 
phate of  potassium  and  carbonate  of  potassium),  oxalic  acid,  etc. 

2.  IRRITANTS. — These     cause     inflammation     of    the     part 
(usually  the  alimentary  canal)  to  which  they  are  applied.    As  ex- 
amples of  irritant  poisons  may  be  mentioned — arsenic,  the  salts  of 
zinc,  and  other  metals,  elaterium,  the  essential  oils,  Spanish  fly. 

3.  NARCOTICS. — These  act  briefly  upon  the  nervous  system, 
producing  stupor,  delirium,  convulsions  or  coma.     As  examples 
of    narcotic   poisons    may    be   mentioned — opium,    prussic    acid, 
belladonna,  chloroform,  chloral,  alcohol,  the  poisonous  gases,  etc. 

4.  NARCOTIC-IRRITANTS.— These   combine   more  or  less 
the  characters  of  narcotics  and  irritants.     As  examples  of  nar- 
cotic-irritants  may  be   mentioned — strychnia,    aconite,   hemlock, 
poisonous  fungi,  etc. 


POISONS.  195 

EVIDENCE  OF  POISONING  IS  AFFORDED  BY  THE 
FOLLOWING  CIRCUMSTANCES,  via.:— 

(i,)  By  the  sudden  appearance  of  the  general  symptoms  of 
poisoning,  such  as  vomiting,  purging,  cramps  in  the  limbs,  pains 
in  the  stomach  or  bowels,  delirium,  unconsciousness,  etc.,  in  a 
person  otherwise  healthy,  or  soon  after  partaking  of  food,  drink 
or  medicine. 

(2,)  By  several  persons  being  attacked  with  similar  severe 
symptoms,  soon  after  a  meal  of  which  all  have  partaken. 

(3»)  By  the  nature  of  the  surroundings,  i.  e.,  by  finding  a  glass 
or  bottle  with  suspicious  looking  contents,  by  the  smell  of  the 
room,  etc. 

(4,)  By  the  history  of  the  case,  i.  e.,  by  the  patient  having 
previously  shown  a  suicidal  tendency,  or  the  signs  of  mental 
depression,  etc. 

HOW  TO  ACT  IN  CASE  OF  POISONING:— 

(i,)  Send  at  once  for  medical  assistance,  and  take  care  that 
the  doctor  is  made  acquainted  with  the  fact  that  the  case  to 
which  he  is  summoned  is  one  of  probable  poisoning. 

(ii,)  During  the  absence  of  skilled  attendance,  act  as  follows, 
•viz. : — 

(a>)  If  y°u  are  in  doubt  as  to  the  nature  of  the  poison  taken, 
adopt  the  general  treatment  applicable  to  a  case  of  unknown 
poisoning  (see  below). 

(b,)  If  you  are  aware  of  the  nature  of  the  poison  taken, 
adopt  the  general  treatment  applicable  to  the  special  poison 
(indicated  in  the  table  given  below). 

THE  GENERAL  TREATMENT  APPLICABLE  TO  A 
CASE  OF  UNKNOWN  POISONING.— Here  the  objects  to  be 
aimed  at  in  treatment  are: — 

(i,)  To  get  rid,  if  possible,  of  the  unabsorbed  poison  from  the 
system;  this  is  effected,  either  by  administering  an  emetic  to 
bring  the  poison  up,  or  an  aperient  to  pass  the  poison  through 
the  alimentary  canal. 

(ii,)  To  counteract  depression  and  shock,  by  giving  stimulants 
and  nourishments,  and  by  the  application  of  warmth  by  means 
of  poultices,  hot  fomentations,  etc. 

(Hi,)  To  relieve  pain,  by  administering  sedatives  and  demul- 
cents. 

EMETICS.— The  following  may  be  used  :— 

'Sulphate  of  Zinc,  grs.  xx  to  xxx  in  half  a  tumbler  of  warm 


196  PASTORAL   MEDICINE. 

water;  this  is  prompt  and  safe,  but  is  not  to  be  given  if  salt  and 
water  has  been  already  administered. 

Ipecacuanha  Powder,  grs.  xv  to  xxx  in  half  a  tumbler  of  warm 
water;  this  produces  very  little  depression  and  does  not  irritate 
the  stomach. 

Ipecacuanha  Wine,  I  to  2  tablespoon fuls  in  an  equal  quantity 
of  water ;  this  produces  a  good  deal  of  depression  and  is  not  very 
prompt  in  its  action. 

Mustard,  a  tablespoonful  in  a  tumbler  of  warm  water. 

Salt,  two  tablespoonfuls  in  a  tumbler  of  warm  water.  This  is 
not  to  be  given  after  sulphate  of  zinc. 

Tepid  Water,  in  large  draughts,  followed  by  irritation  of  the 
back  of  the  throat  by  means  of  the  finger  or  a  feather. 

Any  of  the  above  emetics  may  be  repeated  once  or  twice  if 
necessary.  The  action  of  an  emetic  is  facilitated  by  giving  plenty 
of  tepid  water. 

It  is  important  to  remember  that  patients  suffering  from 
narcotic  poisoning  are  not  easily  made  to  vomit. 

CAUTION. — Emetics  are  not  to  be  given  in  cases  of  corrosive 
poisoning,  which  is  indicated  by  stains  on  the  fingers,  the  lips, 
in  the  mouth,  etc. 

APERIENTS.— The  following  may  be  given  :— 

Castor  Oil,  I  to  2  tablespoonfuls  for  a  dose. 

Sulphate  of  'Magnesia  (Epsom  Salts),  a  tablespoonful  in  a 
tumbler  of  warm  water ;  to  be  repeated  if  necessary. 

STIMULANTS.— Administer  :— 

Sal  Volatile  (Aromatic  Spirits  of  Ammonia),  one-half  to  a  tea- 
spoonful  in  a  tablespoonful  of  warm  water. 

Spirits  (Brandy  or  Whisky),  from  a  tea  to  a  tablespoonful, 
according  to  circumstances. 

Strong  Beef  Tea,  Tea,  or  Coffee. 

The  Hot  and  Cold  Douche  alternately. 

Note. — It  may  (in  cases  where  the  patient  is  unable  to  swallow) 
be  necessary  to  give  spirits,  beef  tea,  tea  or  coffee  by  an  enema. 

SEDATIVES  AND  DEMULCENTS.— These  are  non-irri- 
tating fluids  (which  soothe  internal  local  irritation  and  relieve 
pain),  such  as  milk,  raw  eggs,  barley  water,  arrowroot,  flour 
mixed  in  water,  olive  oil,  linseed  tea,  gruel,  etc. 


POISONS. 


197 


THE  POISONS. 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

i.  THE  ACIDS- 

Immediate    burning 

CAUTION.  —  Emet- 

CO) The  strong  cor- 

sain   in    the    mouth, 

ics  are  not  to  be  given. 

rosive  ones,  viz.  :  — 

:hroat     and    stomach, 

Administer    f  r  e  - 

(i,)  Acetic  (Glacial, 

vomiting  and  purging 

quently    magnesia    or 

and    Aromatic    Vine- 

may occur.    Wherever 

chalk    dissolved    in 

gar). 

the  skin  and  mucous 

warm  water,  then  de- 

(ii,)     Hydrochloric 

membrane  are  touched 

mulcents,  such  as  lime 

(Muriatic,    Spirits   of 

they     are     destroyed, 

water  and  milk,  milk 

Salt). 

there  is  more  or  less 

and  egg,  olive  oil,  J4 

(iii,)   Nitric   (Aqua 

suffocation  and  great 

pint  to  i  pint  of  water, 

fortis). 

shock. 

thick  gruel  ;    if  there 

(iv,)   Sulphuric 

is    depression,    give 

(Oil  of  Vitriol). 

stimulants.      If    any 

acid  has  got  into  the 

air  passages,  make  the 

patient   inhale   the 

fumes  of  ammonia. 

(v,)       Carbolic 

With     the      above 

Administer    Epsom 

(Phenol). 

symptoms  there  is  the 

salts,  l/2  oz.  in  8  ozs.  of 

voidance    of   greenish 

warm     water,     then 

or  black  urine,  and  the 

white   of   egg   mixed 

odor  of  the  acid  can 

with    water    in    large 

be    detected    in    the 

quantities,     or     large 

breath. 

quantities  of  milk,  or 

olive  oil,  2  to  4  ozs.  in 

i    pint   of   water,    or 

castor  oil,  i  oz.  ;  also 

give  stimulants  freely 

and  apply  warmth  to 

the  extremities. 

(vi,)  Oxalic  (Salts 

Burning  pain  in  the 

Avoid  giving  potash, 

of  Lemon  or  Sorrel). 

stomach,  cramp  in  the 
leg,  vomiting  of  dark 
colored  fluid,  a  hack- 

soda, or  ammonia,  or 
their   carbonates,   but 
administer    frequently 

ing  cough  with  a  feel- 

chalk and  water,  mag- 

ing of  constriction  in 

nesia  and  water,  and 

the  throat,  the  mouth 

lime  water,  and  then 

is  white  and  sore,  there 

give  i  oz.  of  castor  oil, 

is    great    shock,    and 

and  stimulants  freely. 

death     may     rapidly 

supervene. 

198 


PASTORAL   MEDICINE. 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

(6)     PRUSSIC 

The  patient  almost 

Administer   emetics 

ACID     (Hydrocyanic 

immediately      after 

first,    then    stimulants 

Acid,  Scheele's  Acid), 

swallowing    the    acid 

freely  and  ad  lib.,  and 

this  may  also  occur  in 

becomes        insensible, 

if     necessary     by     an 

oil    of    almonds,    al- 

with fixed  and  glisten- 

enema,  make  the  pa- 

mond    flavor,     peach 

ing  eyes,  the  pupils  are 

tient  smell  the  fumes 

kernels,  bitter  almond 

dilated  and  insensitive 

of  ammonia,  apply  the 

water,    laurel    water, 

to  light,  the  limbs  are 

hot  and   cold   douche 

and  cyanide  of  potas- 

flaccid, the  skin  is  cold 

alternately,      perform 

sium. 

and    covered    with    a 

artificial       respiration 

clammy    perspiration. 

(about  20  to  the  min- 

the   respirations    are 

ute),  and  keep  it  up 

gasping,  and  occur  at 

steadily,    and    at    the 

long     intervals,     and 

same  time  use  friction 

there  may  be  convul- 

to the  extremities. 

sions. 

NOTE.  —  If  life  can  be 

maintained  for  about 

half  an  hour,  recovery 

is  almost  certain. 

2.   ACONITE 

There  is  warmth  at 

Give    emetics    first, 

(Monkshood,     Blue 

the  pit  of  the  stomach, 

then  stimulants  freely, 

Rocket)  and  its  alka- 

tingling of  the  mouth. 

apply  warmth  to   the 

loids;  occurs  in  aconite 

lips     and    tongue,     a 

lower  extremities,  by 

liniment,       neuraline, 

feeling  of  constriction 

hot  water  bottles  and 

etc. 

in  the  throat,  difficulty 

by    friction    with    the 

in  swallowing,  numb- 

warm hand.     Apply  a 

ness  of  the  tips  of  the 

mustard  poultice  or  a 

fingers,  loss  of  sensa- 

mustard leaf  over  the 

tion,  deafness  and  dim- 

heart, keep  the  patient 

ness  of  sight  ;  this  is 

strictly  in  the  recum- 

followed by  paralysis. 

bent  position  and  per- 

first of  the  lower  and 

form  artificial  respira- 

then of  the  upper  ex- 

tion if  necessary. 

tremities,  the  pulse  is 

NOTE.  —  Stimulants 

irregular    and    almost 

may  have  to  be  given 

imperceptible,  the  res- 

by an  enema. 

pirations  are  shallow, 

feeble  and  infrequent, 

there  may  be  convul- 

sions,  the   pupils   are 

generally  dilated,  there 

is    great    prostration, 

and    death    may   take 

place    quite    suddenly 

after  some  slight  ex- 

ertion. 

POISONS. 


199 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

3.  ALCOHOL,  as  in 

Giddiness,    inability 

Give  emetics  ;  if  the 

rectified,     proof,    and 

to  stand  or  walk,  the 

patient    is    insensible 

methylated     spirit, 

gait   is   tottering,   the 

rouse   him   and   keep 

brandy,  rum,  whisky, 

expression   is   vacant, 

him  awake,  administer 

gin,  etc. 

the  face  is  flushed,  the 

hot  strong  coffee,  ap- 

conjunctivse are  con- 

ply the  hot  and  cold 

gested,    the    lips    are 

douche  alternately  ; 

livid,  the  breath  smells 

when  the  patient  has 

of  alcohol,  the  skin  is 

sufficiently   recovered, 

covered    with    sweat, 

wrap  him  up  in  warm 

the  pupils  are  dilated 

blankets  and  put  him 

and     fixed     or     con- 

to bed. 

tracted,      convulsions 

occur,      stupor      and 

coma. 

4.     THE     ALKA- 

• Immediate    burning 

CAUTION.  —  Emetics 

LIES,     the    strong 

pain    in    the    mouth, 

are  not  to^  be  given, 

caustic  ones,  viz.  :  —  _ 

throat    and    stomach, 

b"f    administer   vine- 

(i),      Ammonia 

vomiting  and  purging, 

gar,  lemon  or  orange 

(Spirits    of    harts- 

the mucous  membrane 

juice,  tartaric  or  citric 

horn,     etc.),     as    in 

of  the   mouth  is   de- 

acid    in     plenty     of 

caustic     ammonia, 

stroyed,  and  there  are 

water  ;     give     demul- 

ammonia       liniment, 

symptoms    of    suffo- 

cents   and    stimulants 

compound      cam- 

cation    and    of   great 

if    required;     if    the 

phor     liniment, 

shock. 

power  of  swallowing 

liquid  ammonia. 

is    lost,    give    inhala- 

(ii,) Lime,  as  caus- 

tions of  acetic  acid  or 

tic  lime,  quicklime. 

vinegar  from  a  pocket 

(Hi,)     Potash,     a  s 

handkerchief. 

caustic  potash. 

(iv,)  Soda,  as  caus- 

tic soda. 
5.  ANTIMONY,  as 

There  is  a  metallic 

Encourage  vomiting 

chloride  or  tartarated 
antimony       (tartar 
emetic),  occurs  also  in 
antimonial  wine,  and 
in  specifics. 

taste    in    the    mouth, 
with   nausea   and   in- 
cessant    vomiting,     a 
feeling  of  heat,   con- 
striction and  choking 
in  the  throat,  pain  in 

by     giving     large 
draughts     of    tepid 
water,  when  the  vomit- 
ing   subsides    admin- 
ister   strong    tea    or 
coffee,    also   white   of 

the    stomach,    violent 

egg  mixed  in  water, 

purging,    and   cramps 

barley   water,    arrow- 

in the  limbs,  the  skin 

root    or   milk.      Give 

is  cold,  the  head  and 

stimulants  if  there  is 

face     are     congested 

collapse.      Wrap    the 

and  there  is  great  de- 

patient   up    in    warm 

pression  and  collapse. 

blankets  and  put  hot 
water   bottles    to   his 

'  feet. 

20O 


PASTORAL   MEDICINE. 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

6.  ARSENIC   (Ar- 

Faintness    and    de- 

Give   emetics,    and 

senious    acid,     White 

pression  followed  by  a 

then  large  draughts  of 

arsenic),     may     also 

burning    pain    in    the 

tepid  greasy  or  soapy 

occur    in    Aqua    To- 

stomach,  vomiting  of 

water,     or     salt     and 

fana,  fly  papers, 

brown   matter   mixed 

water,  dialysed  iron  in 

mineral,    Vienna    and 

with    mucus    and 

I   oz.  doses,   or  mag- 

other  emerald   green, 

streaks  of  blood,  purg- 

nesia in  large  quanti- 

rat   paste,    vermin 

ing,  severe  cramps  in 

ties,   these   are  to  be 

killer,     cheap    ices, 

the  calves  of  the  legs, 

frequently     repeated  ; 

crayons,     French 

constriction  and   dry- 

give  olive  oil  Yz  pint 

chalks,     wall    papers, 

ness    of    the    throat, 

in  i  pint  of  lime  water, 

and  tinned  fruits,   (as 

great  thirst,  hiccough. 

administer    d  e  m  u  1  - 

an    impurity    of    the 

loss     of    voice,     cold 

centsj  if  there  is  de- 

tin). 

sweats,    profound 

pression,    give   stimu- 

shock and  exhaustion. 

lants  freely,  and  apply 

warmth  and  friction; 

after  the  acute  symp- 

toms have  passed  off, 

apply     linseed     meal 

poultices  to  the  abdo- 

men. 

7.  BELLADONNA 

Heat  and  dryness  of 

Give    emetics    first, 

(the    Deadly    Night- 

the mouth  and  throat, 

then  strong  hot  coffee 

shade)    and  its  alka- 

suppression of  saliva, 

and  stimulants,  apply 

loid  atropine. 

difficulty  of  swallow- 

mustard to  the  calves 

ing   and   great  thirst, 

of   the   legs   and   hot 

the  face  is  flushed,  the 

water   bottles    to   the 

eyes  are  prominent  and 

feet,     administer     the 

sparkling,  the  vision  is 

hot  and  cold  douche 

double    or    indistinct. 

alternately,    and    per- 

the pupils  are  dilated 

form  artificial  respira- 

and insensible  to  light, 

tion. 

there  is  great  excite- 

ment  and    noisy    de- 

lirium, the  gait  is  un- 

steady and  staggering. 

there    is    a    frequent 

desire  to  pass  water, 

with  inability  to  do  so. 

the    skin    is    dry    and 

there  may  be  a   rash 

like    that    of    scarlet 

fever. 

POISONS. 


201 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

8.  CANTHARIDES 

Burning  sensation  in 

Give     emetics     and 

(Spanish  Fly,   Blister 

the  throat  and  stom- 

then   demulcents,    es- 

Beetle), occurs  also  in 

ach,     with    pain    and 

pecially  white  of  egg 

blistering  fluid. 

difficulty   in    swallow- 

and    milk     or     thick 

ing,  vomiting  of  mucus 

gruel,  but  avoid  giv- 

and   blood,    diarrhoea 

ing     fats     and     oils; 

with  blood  and  slime 

when  the  acute  symp- 

in the  motions,  inces- 

toms   have    been    re- 

sant   desire    to    pass 

lieved,    give    the    pa- 

water,  high  tempera- 

tient    a    hot    bath    or 

t  u  r  e  ,     quick     pulse, 

apoly  hot  linseed  meal 

headache,  loss  of  sen- 

poultices to  the  abdo- 

sibility, convulsions. 

men. 

9.    CAMPHOR,   as 

Odor  of  the  breath, 

Give     emetics     and 

in    the    essence,    lini- 

languor,       giddiness, 

then  stimulants  freely, 

ment    and    spirits    of 

faintness,    disturbance 

apply  warmth  to  the 

camphor. 

of  vision,  noises  in  the 

extremities    and    ad- 

ears, delirium  and  con- 

minister the  hot  and 

vulsions,   a   cold    and 

cold    douche    alter- 

clammy    skin,     weak 

nately. 

pulse      and      difficult 

breathing. 

10.  CAUSTIC,  LU- 

Pain and  discolora- 

Give  common    salt 

NAR  (Nitrate  of  sil- 

tion of  the  mouth  and 

dissolved  in  water  or 

ver) 

throat,     followed    by 

milk  freely,  give  emet- 

T V*  /  . 

vomiting    of    whitish 

ics   (but  not  sulphate 

flaky     matter     which 

of  zinc),  and  demul- 

turns black. 

cents. 

ii.    CHLORAL 

Deep  sleep,  with  loss 

Give  emetics,   wrap 

(Chloral    hydrate, 
Syrup  of  chloral). 

of    muscular    power, 
diminished  sensibility, 
the  face  is  livid  and 

the  patient  up  in  warm 
blankets,  and  apply  hot 
water    bottles   to    the 

bloated,   the   pulse   is 

feet,  keep  the  patient 

slow  or  very  weak,  the 

roused  by  shouting  or 

respirations     are     di- 

flapping his  face  with 

minished,  and  the  sur- 

a wet  towel,  give  hot 

face   of  the   body   is 

strong  coffee,  and  per- 

cold. 

form  artificial  respira- 

tion   if   there    is    the 

slightest  failure  of  the 

breathing. 

12.  CHLORINE 
GAS,  as  in  chloride  of 
lime. 

Irritation    of    the 
throat,    cough,    tight- 
ness of  the  chest,  diffi- 
culty of  breathing  and 

Admit     plenty     of 
fresh  air,  give  inhala- 
tions of  steam  or^  of 
very  dilute  ammonia. 

inability  to  swallow. 

202 


PASTORAL   MEDICINE. 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

13.  CHLOROFORM 

The  respirations  are 

Pull  the  tongue  for- 

(inhaled). 

arrested,  the  breathing 

ward,     see    that    the 

is  stertorous,  and  the 

mouth  and  throat  are 

face  is  livid. 

clear,    loosen     every- 

thing tight  about  the 

chest,  flap  the  face  and 

chest  with  a  wet  towel. 

give    plenty    of    fresh 

air,  apply  the  hot  and 

cold     douche      alter- 

nately to  the  chest  and 

head,     and     perform 

artificial  respiration. 

14.  CHLOROFORM 

The  breath  smells  of 

Give    emetics    first, 

(swallowed). 

chloroform,  the  gait  is 

then  carbonate  of  soda 

staggering,  this  is  fol- 

dissolved in  plenty  of 

lowed  by  insensibility. 

water,   rouse   the   pa- 

the pupils  are  dilated, 

tient  in  every  possible 

the  breathing  is  ster- 

way, apply  mustard  to 

1 

torous,  the  skin  is  cold 

the  calves  of  the  legs 

and  the  pulse  is  im- 

and   a    mustard    leaf 

perceptible. 

over  the  heart 

15.     COPPER,    as 

There  is  a  metallic 

First    give    large 

the    sulphate     (blue 

taste    in    the    mouth, 

quantities  of  milk  and 

vitriol,  blue  stone),  or 

constriction     in     the 

eggs,  then  emetics  (if 

the     acetate     (verdi- 

throat     and      gullet. 

there  is  no  vomiting), 

gris). 

griping     and     colicky 

and    then    large 

pains  in  the  abdomen, 

draughts    of    tepid 

nausea,  vomiting  and 

water,  after  that  barley 

purging,      d  5  ffi  c  u  1  1 

water,    arrowroot    or 

breathing,  quick  pulse, 

gruel,   and   apply  hot 

great     weakness     and 

linseed  meal  poultices 

thirst,    cold    perspira- 

to the  abdomen. 

tion,   coldness  of  the 

limbs,  headache,   gid- 

diness,    and     finally 

coma. 

16.  CROTON  OIL. 

Great  pain  in  the  ab- 

Give   emetics    first, 

domen,  with  vomiting 

then   demulcents,    es- 

and purging,  the  face 

pecially  white  of  egg 

is    pale,    the    features 

in    milk,    and    stimu- 

are pinched,  the  pulse 

lants  freely,  and  apply 

is   small,   the  skin   is 

hot    linseed    meal 

moist,    and    there    is 

poultices  to  the  abdo- 

great collapse. 

men. 

POISONS. 


203 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

17.     ERGOT     O  F 

Tingling  and  cramp 

Give    emetics    first, 

RYE    and    its    alka- 

of the  limbs,  dizziness, 

then  castor  oil,  after 

loids,  ergotine,  etc. 

weakness,    itching 

that    strong    tea    and 

vomiting     and     diar- 

stimulants,   keep    the 

rhoea. 

patient  in  a  recumbent 

position,     and     apply 

warmth    to    the    ex- 

tremities. 

18.     ETHER     (in- 

Same as  chloroform 

Same  as  chloroform 

haled). 

inhaled. 

inhaled. 

19.     FUNGI     (Fly 

There     is     violent 

Give    emetics    first, 

fungus,    poisonous 

colic,    with    vomiting 

then  castor  oil  i  oz., 

mushrooms). 

and    diarrhoea,    great 

then  stimulants  freely, 

excitement    and    then 

apply  warmth  to  the 

coma,    the    pulse    is 

extremities    and    hot 

slow,  the  breathing  is 

linseed  meal  poultices 

stertorous,  the  pupils 

to  the  abdomen. 

are    dilated,    and   the 

extremities  are  cold. 

20.    THE   GASES, 

There  is  irritation  of 

Remove  quickly  to 

viz.,  carbonic  acid  or 

the  throat,  with  head- 

the fresh  air,  and  per- 

carbonic    oxide     gas, 

ache,  drowsiness,  gid- 

form artificial  respira- 

coal gas  or  sewer  gas, 

diness,  and  singing  in 

tion,    apply    smelling 

choke  damp  or  after 

the  ears,  loss  of  mus- 

salts   to  the    nostrils, 

damp,      marsh      gas, 

cular   power,   lividity, 

and  cold  to  the  head 

charcoal    fumes,    and 

hurried      respirations 

and    chest,    and   give 

acetylene. 

and  coma. 

stimulants. 

21.  HOLLY  BER- 

There  is  vomiting, 

Give    emetics,    and 

RIES. 

with  pain  in  the  head 

then  stimulants  freely. 

and     abdomen,     and 

apply      friction      and 

purging,  the  pupils  are 

warmth    to    the    ex- 

contracted, then  drow- 

tremities. 

siness      followed     by 

unconsciousness     and 

collapse  supervene. 

22.  HYOSCYA- 

MUS  (henbane),  and 
its  alkaloids  hyoscya- 
mine,  etc. 

Much  the  same  as 
belladonna,  i.  e.,  thirst, 
dilated    pupils,    delir- 
ium, etc. 

Give    emetics    first, 
then  stimulants  mod- 
erately, and  apply  the 
hot  and  cold  doudV 
alternately. 

204 


PASTORAL   MEDICINE. 


Special  Poisons 

Their  Symptoms 

Their  G  eneral  Treatment 

23.     IODINE    and 

Pain    and    heat    in 

Give    emetics    first, 

IODOFORM. 

throat    and    stomach. 

then  starch  and  water, 

with     vomiting     and 

or    gruel    and    water, 

purging  (the  vomited 

or  white  of  eggs  and 

matter    yellow    or 

water  freely. 

blue),     followed     by 

giddiness    and    faint- 

ness  with  convulsions. 

24.     LABURNUM 

There    is    purging, 

Give    emetics   first, 

and  its  active  principle 

vomiting,    and     great 

then      stimulants      in 

cytisine,  which  is  also 

restlessness,     this     is 

moderation,    and    ad- 

present in  Arnica. 

followed    by    drowsi- 

minister the  hot  and 

ness,  insensibility  and 

cold    douche    alter- 

convulsive twitchings. 

nately    to    head    and 

chest. 

25.   LEAD   as  ace- 

There is  dryness  of 

Give  emetics  freely, 

tate   (sugar  of  lead), 

the     throat,     with     a 

then  Epsom  salts  (£2 

lead    paint    or    white 

metallic  taste  and  great 

07     in   a   tumbler   of 

lead  ;    may    occur    in 

thirst,  colicky  pains  in 

warm  water),  then  de- 

crayons, French  chalk 

the  abdomen  which  are 

mulcents,    and    apply 

and  hair  dyes. 

relieved   by   pressure, 

hot  linseed  meal  poul- 

constipation,     cramps 

tices  to  the  abdomen. 

in  the  legs,  cold  sweats, 

paralysis  of  lower  ex- 

tremities, convulsions. 

26.  MERCURY,  as 

If    corrosive    subli- 

First give  white  of 

corrosive      sublimate, 

mate   or   the   acid  ni- 

egg mixed  with  water 

perchloride     of    mer- 

trate is  taken,  the  lips 

or    flour    and    water. 

cury,    red    and   white 

and  mouth  are  white 

then  give  emetics  free- 

precipitate, red  oxide 

and    swollen,    the 

ly,   after   this    demul- 

of  mercury,   and   the 

tongue    is    white    and 

cents  and  stimulants. 

acid   nitrate   of   mer- 

shrivelled, and  there  is 

cury. 

a  sense  of  constriction 

in  the   throat  ;  in  all 

cases  of  poisoning  by 

mercury    there    is    a 

metallic   taste   in   the 

mouth,    pain    in    the 

stomach,     nausea, 

vomiting    of     stringy 

mucus     mixed     with 

blood,    profuse    purg- 

ing with  bloody  stools, 

a    cold    and    clammy 

skin,  difficult  respira- 

tions,     syncope     and 

convulsions. 

POISONS. 


205 


Special  Poisons 


Their  Symptoms 


Their  General  Treatment 


27.  MUSSELS,  also 
PTOMAINES  (ani- 
mal alkaloids,  poison- 
ous meat,  poisonous 
fish). 


28.  NITROUS  OX- 
IDE GAS  (laughing 
gas). 


29.  NITRO-BEN- 
ZOL  (nitro-benzine, 
artificial  oil  of  bitter 
almonds,  essence  of 
henbane).  Also 
present  in  aniline 
dyes,  liqueurs,  sweet- 
meats, pomades. 


30.  NUX  VOMICA 
(St.  Ignatius'  bean), 
and  its  alkaloid 
STRYCHNIA  (as  in 
vermin  killer). 


There  is  uneasiness 
and  weight  at  the  pit 
of  the  stomach,  a  sen- 
sation of  numbness  in 
the  extremities,  heat, 
dryness  and  constric- 
tion in  the  throat, 
thirst,  shivering,  diffi- 
culty of  breathing, 
cramps  in  the  legs, 
inflammation  of  the 
eyes,  colic,  vomiting 
and  purging,  itching 
of  the  skin,  failure  of 
the  heart's  action  and 
collapse. 


Same  as  chloroform 
inhaled. 


There  is  weakness 
and  discomfort,  great 
nausea  and  anxiety, 
confusion  of  the  mind, 
lividityof  the  face  and 
body,  dilated  pupils 
and  convulsions. 


Violent  rigid  con- 
vulsions, with  lockjaw 
during  the  convulsive 
attack;  the  eyeballs 
are  prominent,  the 
pupils  dilated,  the  res- 
pirations impeded,  and 
the  pulse  feeble  and 
very  rapid.  Death 
usually  takes  place 
either  from  asphyxia 
or  from  collapse  dur- 
ing a  paroxysm. 


Give  emetics  first, 
then  castor  oil  I  oz., 
then  stimulants  freely, 
apply  hot  water  bot- 
tles to  the  feet,  and 
wrap  the  patient  up  in 
warm  blankets. 


Same  as  chloroform 
inhaled. 


Give  emetics  first, 
then  stimulants  freely, 
apply  the  hot  and  cold 
douche  alternately, 
and  perform  artificial 
respiration. 


Give  emetics  first, 
then  animal  charcoal 
ad  lib.  mixed  in  water, 
followed  by  an  emetic; 
if  possible  perform 
artificial  respiration. 


206 


PASTORAL   MEDICINE. 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

31.    OPIUM    (lau- 

Mental   excitement, 

Give    emetics    first, 

danum)    and    its    al- 

followed by  headache, 

rouse    and    keep    the 

kaloids        (morphine, 

uneasiness,  a  sensation 

patient  awake  in  every 

codeine,    etc.),    occur 

of  weight  in  the  limbs, 

possible  way,  by  mak- 

in tincture  and  wine 

incapacity    for    exer- 

ing him  walk  about,  or 

of     opium,     sedative 

tion,   sleepiness,   dim- 

flapping  him    with   a 

solutions,    C  h  1  o  r  o  - 

inution  of  sensibility, 

wet  towel,  apply  am- 

dyne,    Carminative, 

and  contraction  of  the 

monia  or  sal  volatile 

Cordial    and    Elixirs, 

pupils;     at    first    the 

to  the  nostrils,  give  a 

Mother's   Friend   and 

patient  can  be  roused 

pint     of    hot    strong 

Soothing  Syrups,  Syr- 

with    difficulty,     but 

coffee,  rpply  the  cold 

up  of  Poppies,  Pare- 

later  on   he   becomes 

douche  to  the  head  fre- 

goric and  many  kinds 

quite    insensible,    his 

quently,  perform  arti- 

of patent  medicines. 

muscles    are    relaxed, 

ficial    respiration    and 

his   skin   is   cold,   the 

keep  it  up  at  least  for 

pupils  fail  to  respond 

two    hours.     Do    not 

to  light,  his  face  and 

give  wine  or  brandy. 

lips  are  cold  and  blue, 

CAUTION.  —  In  mak- 

the   respirations    are 

ing   the  patient  walk 

slow,    irregular,    and 

about  be  careful  not  to 

stertorous,     and    the 

overexhaust    him.    as 

pulse    is    weak    and 

with  opium  poisoning 

compressible. 

there  is  always  a  cer- 

tain   amount    of    de- 

pression. 

32.  PARAFFIN 

The  symptoms  vary 

Give    emetics    first, 

OIL. 

very  much,  there  may 

then  stimulants  freely, 

be   a   burning    sensa- 

and apply  warmth  to 

tion    in    the    mouth, 

the  body. 

gullet  or  stomach,  and 

great  thirst  ;   the   ex- 

tremities are  cold,  the 

face  is  pale,  the  pulse 

is  feeble,  the  respira- 

tions  are    weak,    and 

often  there  is  coma. 

33.  PHOSPHORUS 

Pain  in  the  stomach. 

Give    emetics    first. 

(as    in    matches, 

vomiting,  the  vomited 

then  Epsom  salts   (^2 

phosphorus     paste, 

matter  may  be  lumin- 

oz.   in   a   tumbler   of 

rat     poison,     vermin 

ous  in  the  dark,  odor 

water),   stimulants   if 

killer,  rat  paste). 

of  phosphorus  in  the 

required,   and   demul- 

breath, bleeding  from 

cents,  especially  milk. 

the  nose,  blood  stained 

Avoid    giving    fats 

motions,   and  convul- 

and oils. 

sions. 

POISONS. 


207 


Special  Poisons 

Their  Symptoms 

Their  General  Treatment 

34.     TIN    and    its 

The  same  as  in  lead 

Give    emetics    first, 

salts. 

poisoning. 

then    sal    volatile    in 

water,    and   white  of 

egg  in  milk. 

35.  TOBACCO  and 

Nausea  and  vomit- 

Give  emetics    first, 

its   alkaloid,   nicotine. 

ing,  accompanied  with 

then   strong  tea,  and 

great    weakness    and 

stimulants  freely,  ap- 

Faintness, confusion  of 

ply  warmth  to  the  ex- 

ideas, dimness  of  sight, 

tremities  and  keep  the 

weak  pulse,  cold  skin, 

patient  in  a  recumbent 

covered  with  clammy 

position. 

perspiration,  pupils  at 

first    contracted    and 

then  dilated. 

36.  TURPENTINE 

Odor  in  the  breath, 

Give    emetics    first, 

(oil  and  spirits  of  tur- 
pentine,  turps,   cam- 
phene). 

intoxication,        pupils 
contracted,    breathing 
stertorous,  coma,  col- 

then Epsom  salts   (i 
oz.  in  half  a  tumbler 
of  warm  water),  and 

lapse  and  tetanic  con- 

demulcents. 

vulsions,       irritability 

of    the    bladder,    the 

urine  having  the  smell 

of  violets.    The  symp- 

toms    of     turpentine 

poisoning        resemble 

somewhat     those     of 

opium. 

37.    ZINC,    as   sul- 
phate (white  vitriol), 
and   chloride    (Disin- 
fecting Fluid). 

Corrosion  of  the  lips 
and    of    the    mucous 
membrane     o  f     the 
mouth,   pain   and   in- 
cessant vomiting,  the 

Do  not  give  emetics, 
but    give    first    large 
draughts  of  milk  and 
white  of  egg,  and  then 
bicarbonate  of  soda  or 

pulse  and  respirations 
are      quickened,      the 

common  soda  in  large 
quantities  dissolved  in 

pupils  are  dilated,  the 

warm  water,  and  then 

muscles  are  paralyzed, 
and  coma  supervenes. 

strong  tea,  apply  lin- 
seed meal  poultices  to 

the  abdomen. 

Note.— The  following  Poisons  are  frequently  taken  either  acci- 
dentally or  for  suicidal  purposes,  viz     Carbolic  acid,  Oxahc  acid, 
Prussic     acid,    Arsenic,     Opium,     Phosphorus,     Strychnia     (Nra 
vomica),  Lead   (Sugar  of),  and  Mercury   (Red  and  White  Pr< 
cipitate). 


208  PASTORAL   MEDICINE. 

VI. — THE    IMMEDIATE    TREATMENT   OF 
INSENSIBILITY   AND    FITS. 

Insensibility. 

Loss  of  consciousness  may  be  produced  by  the  following 
causes: — 

1,  Syncope,  or  fainting. 

2,  Asphyxia,  or  suffocation. 

3,  Shock  and  collapse. 

4,  Concussion  of  the  brain. 

5,  Compression  of  the  brain. 

6,  Apoplexy. 

7,  Alcoholic  intoxication. 

8,  Narcotic  poisoning,  as  opium  poisoning. 

9,  Sunstroke. 
10,  Freezing. 

Unconsciousness  is  also  present  in  the  following: — 

1,  Epilepsy. 

2,  The  convulsions  of  infants. 

3,  Uraemic  poisoning,  which  often  comes  on  in  the  course  of 
kidney  disease  and  is  due  to  the  non-excretion  (by  the  kidneys) 
of  the  waste  material  in  the  blood. 

But  as  convulsions  form  the  most  prominent  symptom,  these 
diseases  are  dealt  with  separately  under  "  Fits." 

i,  SYNCOPE,  or  FAINTING,  may  be  due  to  mental  emotion, 
pain,  extreme  exhaustion  (as  from  hunger,  fatigue,  etc.),  hem- 
orrhage, cold,  heat  (particularly  if  combined  with  a  close  atmos- 
phere, as  in  heated  rooms,  in  large  crowds,  etc.),  constriction  of 
the  chest  (as  in  tight  lacing,  etc.),  and  organic  disease  of  the 
heart. 

Symptoms. — Fainting  is  generally  ushered  in  by  a  feeling  of 
giddiness  and  fluttering  at  the  heart.  This  is  followed  by  the 
face  becoming  suddenly  pale  and  the  lips  white;  the  pulse 
becomes  weakened  and  the  breathing  quickened ;  a  cold  sweat 
appears  on  the  brow  and  the  palms  of  the  hands;  the  patient 
staggers  and  finally  falls  to  the  ground  in  an  unconscious  state. 
Rarely  convulsive  movements  of  the  whole  body  may  also  be 
present. 


INSENSIBILITY  AND  FITS,  209 

TREATMENT.— As  fainting  is  caused  by  a  diminution  of  the 
supply  of  blood  to  the  brain  from  partial  paralysis  of  the  heart, 
the  object  to  be  aimed  at  in  treatment  is  to  restore  the  cerebral 
circulation;  therefore,  when  a  person  has  fainted,  do  not 
attempt  to  place  him  in  a  sitting  or  standing  posture  (as  this 
will  only  embarrass  the  already  weakened  action  of  the  heart, 
and  may  be  fatal),  but  lay  him  flat  on  his  back,  or,  better  still, 
on  his  left  side  with  his  pelvis  and  feet  slightly  raised;  loosen 
all  tight  clothing  about  his  body  and  neck;  give  him  plenty  of 
fresh  air;  sprinkle  cold  water  on  his  face,  apply  smelling  salts 
to  his  nostrils ;  when  able  to  swallow,  give  him  a  glass  of  water 
or  a  little  brandy,  whisky,  or  sal  volatile  mixed  in  water,  and 
keep  him  in  the  recumbent  position  for  some  time  after  he  has 
recovered.  If  the  faint  is  prolonged  and  consciousness  does  not 
return,  send  for  medical  assistance,  but  in  the  meanwhile  apply 
warmth  to  the  feet  and  a  hot  mustard  plaster  over  the  region  of 
the  heart,  and  if  natural  breathing  has  not  returned,  perform 
artificial  respiration  by  the  "Sylvester"  method  (page  187). 

In  a  crowded  room  a  fainting  fit  may  be  prevented  by  placing 
the  patient  in  a  stooping  position  on  a  chair  and  bending  his 
head  between  his  knees.  The  person  must  be  held,  for  if  he 
faints  in  this  position  he  dives  forward  on  to  his  head,  and  may 
turn  a  somersault  or  might  break  his  neck.  If  the  patient  has 
completely  fainted  this  treatment  is  not  to  be  attempted,  as  it 
only  helps  to  obstruct  the  circulation  and  respiration. 

2,  ASPHYXIA.— This  has  been  dealt  with  on  page  190. 

3,  SHOCK,  or  COLLAPSE,  may  be  produced  by  severe  in- 
juries or  emotional  disturbance,  causing  a  profound  depressing 
effect  upon  the  central  nervous  system. 

The  injuries  most  liable  to  produce  shock  are: — 

(i,)  Those  involving  large  surfaces  of  the  skin,  as  in  burns 
and  scalds. 

(ii,)  Those  causing  crushing  or  tearing  of  the  body,  as  ma- 
chinery and  railway  accidents. 

(iii,)  Those  affecting  the  abdomen  and  viscera. 

Loss  of  blood  and  exposure  to  cold  intensify  the  condition  of 
shock. 

Symptoms.— A  person  in  a  state  of  shock  presents  the  follow- 
ing appearance :  He  lies  flat  on  his  back,  his  limbs  are  flaccid, 
and  he  makes  no  spontaneous  movements;  his  body  is  cold  and 
clammy,  his  face  is  pale,  his  eyes  are  sunken,  his  pulse  is  small, 


PASTORAL  MEDICINE. 

feeble  and  irregular,  his  respirations  are  shallow,  feeble  and 
sighing,  his  temperature  falls  to  97°  F.  or  a  degree  or  two 
lower,  and  he  is  semi-unconscious. 

Should  a  case  of  shock  tend  to  terminate  favorably,  the  con- 
dition known  as  that  of  "  Reaction  "  comes  on.  This  is  usually 
ushered  in  by  the  patient  vomiting,  the  pulse  then  becomes 
stronger,  the  body  warmer,  and  color  returns  to  the  face. 

TREATMENT.— The  object  to  be  aimed  at  in  treatment  is  to 
bring  about  reaction  by  the  application  of  warmth  and  the 
administration  of  stimulants.  Therefore,  to  treat  shock  place 
the  patient  in  bed  between  blankets  as  soon  as  possible,  keeping 
his  head  quite  low.  Apply  hot  water  bottles  to  his  feet  and 
between  his  thighs,  and  apply  friction  to  his  arms  and  legs. 

If  able  to  swallow,  give  him  small  quantities  of  hot  stimulants, 
and  frequently  repeat  them  till  reaction  takes  place,  then  lessen 
the  stimulants  considerably,  taking  care  not  to  over  stimulate. 

During  the  state  of  collapse,  should  the  breathing  become 
embarrassed,  perform  artificial  respiration  according  to  the 
"Sylvester"  method  (page  187). 

4,  CONCUSSION   OF  THE  BRAIN   is  caused   usually  by 
blows  or  falls  upon  the  head,  or  falls  upon  the  feet  or  lower  end 
of  the  spine,  the  effect  being  a  severe  shaking  up  of  the  brain 
substance. 

Symptoms. — These  vary  in  their  severity  according  to  the 
force  of  the  blow  applied. 

The  patient  may  present  the  appearance  of  being  merely 
stunned,  or  he  may  be  in  a  condition  identical  with  that  already 
described  under  "  Shock." 

TREATMENT. — The  same  as  for  shock;  and  at  the  same  time 
apply  cold  in  the  form  of  ice  or  wet  cloths  to  the  head.  Avoid 
alcoholic  stimulants,  but  give  instead  hot  beef  tea  or  hot  coffee, 
and  keep  the  patient  absolutely  quiet  in  a  darkened  room. 

5,  COMPRESSION  OF  THE  BRAIN  is  caused  by  injuries 
to  the  head  producing  pressure  of  the  brain  substance  either  by 
the  depression  of  a  piece  of  bone  onto  it,  or  by  a  blood  clot  (pro- 
duced by  the  rupture  of  a  blood-vessel). 

Symptoms. — Resemble  those  of  apoplexy,  which  see. 
TREATMENT. — If   there    is    a    wound   on    the   head,    dress    it; 
otherwise  adopt  the  same  treatment  as  for  apoplexy. 

6,  APOPLEXY  is  caused  by  the  bursting  of  a  diseased  blood- 
vessel into  the  substance  of  or  upon  the  surface  of  the  brain, 


INSENSIBILITY  AND  FITS.  an 

causing  compression  of  that  organ.  It  usually  occurs  in  elderly 
persons. 

Symptoms.— Just  before  the  attack  there  are  generally  some 
premonitory  symptoms,  such  as  headache,  giddiness,  especially 
on  stooping,  weight  and  fulness  in  the  head,  noises  in  the  ears. 
When  the  actual  attack  occurs,  the  patient  is  more  or  less  un- 
conscious, his  face  is  flushed,  his  breathing  is  shallow  and  ster- 
torous; his  eyes  are  insensible  to  light  and  touch,  the  pupils 
are  fixed,  and  are  either  unequally  dilated,  or  one  or  both  may 
be  contracted;  his  pulse  is  full  and  slow,  and  there  is  paralysis 
more  or  less  affecting  one  side  of  the  body. 

TREATMENT. — The  object  of  treatment  is  to  get  the  circulation 
quiet  and  the  heart's  action  free  from  embarrassment;  there- 
fore loosen  all  tight  clothing  about  the  neck  and  chest,  put 
the  patient  to  bed  with  his  head  raised,  and  apply  cold  to 
it;  apply  hot  water  bottles  to  his  feet  and  mustard  poultices 
to  the  calves  of  his  legs.  Be  careful  to  give  nothing  by  the 
mouth  (as  it  may  choke  the  patient),  and  send  for  medical 
assistance. 

7,  ALCOHOLIC  INTOXICATION:— 

Symptoms. — A  person  in  a  state  of  stupor  from  alcohol 
presents  the  following  picture:  He  is  semi-unconscious,  and 
can  be  partially  roused,  his  face  is  flushed  and  bloated,  his  eyes 
are  reddened  and  blood-shot  but  are  not  insensible  to  touch,  his 
pupils  are  equally  dilated  and  fixed,  his  lips  are  livid,  his 
breathing  is  slow,  the  surface  of  his  body  is  cold,  and  he  may 
smell  of  liquor. 

Note. — Alcoholic  stupor  may  be  hard  to  distinguish  from 
apoplexy,  but  the  state  of  the  pupils,  the  sensitiveness  of  the 
eyes  to  touch,  and  the  presence  or  absence  of  paralysis  will  help 
to  determine  the  condition. 

TREATMENT.— (See  "Poisons,"  page  IQ9-) 

CAUTION.— If  in  doubt  as  to  whether  a  person  is  suffering 
from  drunkenness  or  apoplexy,  treat  him  for  the  latter  and  be  par- 
ticularly careful  not  to  make  him  vomit. 

8,  NARCOTIC    POISONING.— (See    "Opium    Poisoning," 
page  206.) 

9,  SUNSTROKE  is  caused  by  exposure  to  the  rays  of  the  sun. 
Symptoms.— Sunstroke  is  ushered  in  with  giddiness,   nausea, 

and  weakness;  this  is  followed  by  drowsiness  and  more  or  less 
unconsciousness.  The  eyes  are  blood-shot,  the  skin  is  hot  and 


2i2  PASTORAL  MEDICINE. 

dry,  the  breathing  is  quick  and  noisy;  the  pupils  are  contracted 
at  first  and  become  dilated  afterwards;  the  pulse  may  be  slow 
or  quick,  and  there  may  be  convulsions. 

TREATMENT. — Place  the  patient  in  a  cool,  shady  spot;  remove 
the  clothing  from  the  neck  and  upper  part  of  the  body  and  raise 
the  head ;  douche  the  head,  neck,  chest  and  spine  with  cold 
water,  or  wrap  cold  sheets  round  him,  and  continue  these  cold 
applications  till  he  becomes  conscious,  then  remove  him  to  bed, 
keep  the  room  darkened,  and  watch  him  carefully;  if  the 
unconsciousness  returns,  renew  the  application  of  cold. 

10,  FREEZING:— 

TREATMENT. — Take  the  patient  into  a  room  which  has  no  fire 
in  it,  rub  the  body  with  ice-cold  or  snow  water  and  restore 
warmth  gradually. 

It  is  dangerous  to  apply  heat  too  early ;  as  soon  as  the  patient 
is  able  to  swallow  give  him  stimulants  and  hot  drinks. 

TEST  FOR  INSENSIBILITY.— To  determine  whether  a 
person  is  insensible,  raise  the  eyelid  and  touch  the  white  of  the 
eye,  blinking,  which  can  not  be  avoided  if  the  person  is  con- 
scious, does  not  occur. 

HOW  TO  ACT  IF  A  PATIENT  IS  FOUND  IN  A  STATE 
OF  UNCONSCIOUSNESS.— Before  efficient  help  can  be  ren- 
dered, the  first  thing  to  do,  is  to  try  and  arrive  at  the  cause 
which  has  produced  the  state  of  unconsciousness,  and  in  order 
to  do  this  a  systematic  examination  of  the  patient  and  his  sur- 
roundings must  be  made,  therefore  proceed  as  follows : — 
(i,)  Notice  position  of  the  body  and  its  surroundings. 

(ii,)  Notice  whether  the  body  is  lying  still  or  there  are  con- 
vulsive movements. 

(iii,)  If  possible  obtain  all  information  as  to  the  cause. 

(iv,)  Lay  the  patient  on  the  back,  inclining  the  head  to  one 
side  (to  prevent  the  tongue  from  falling  back  or  vomited  matter 
going  down  the  trachea)  ;  if  the  face  is  flushed  slightly  raise  the 
head,  if  the  face  is  pale  keep  the  head  flat,  place  the  arms  by 
the  sides  and  extend  the  legs,  and  loosen  all  tight  clothing  about 
the  neck  and  chest. 

(v,)  Examine  the  head,  to  ascertain  whether  there  is  a 
depressed  wound  (which  would  suggest  compression),  or  a  mere 
bruising  (which  would  suggest  stunning). 

(vi,)  Examine  the  eyes  to  see  if  they  are  sensitive  to  light 
and  touch,  if  there  is  any  squinting,  and  the  state  of  the  pupils ; 


INSENSIBILITY  AND  FITS. 


213 


(a,)  If  sensitive  to  touch,  no  brain  injuries  are  present, 
(fe),  If   the   pupils   are   unequally   contracted   there    is   brain 
trouble. 

(O  If    the   pupils    are   equally    contracted,    there    is    opium 
poisoning. 

(vii,)  Examine  the  face; 

(a,)  If  it  is  drawn  to  one  side,  this  will  indicate  apoplexy  or 
compression  of  the  brain. 

(&,)  If  it  is  bloated  and  flushed,  this  will  suggest  the  excessive 
use  of  alcohol. 

(viii,)  Smell  the  breath,  the  odor  of  opium  or  alcohol  may 
be  detected. 

(ix,)  Examine   the  mouth   and   tongue,    froth   in  the  mouth 
and  a  bite  on  the  tongue  will  indicate  fits,  particularly  epileptic, 
(x,)  Notice  the  breathing; 

(a,)  If  it  is  slow,  it  indicates  great  weakness  as  in  shock. 
(&,)  If  it  is  snoring  (stertorous),  it  indicates  brain  trouble, 
(xi,)  Examine  the  pulse; 
(a,)  If  it  is  slow,  there  is  brain  trouble. 
(&,)  If  it  is  rapid,  there  is  sunstroke  or  fever, 
(c,)  If  it  is  quick  and  thready,  there  is  great  weakness— such 
as  shock. 

(xii,)  Feel  the  surface  of  the  body; 

(a,)  If  the  skin  is  abnormally  cold,  there  is  either  freezing, 
intoxication,  collapse,  or  fainting. 

(&,)   If  the  skin  is  hot,  there  is  sunstroke  or  high  fever, 
(xiii,)  Examine  the  ribs,  collar  bones  and  limbs  for  fractures, 
(xiv,)  Examine  the  limbs  to  see  if  there  is  any  paralysis;  this 
is  done  by  raising  the  limbs  and  allowing  them  to  fall,  if  they 
do  so  lifelessly  it  suggests  paralysis. 

(xv,)  If  convulsive  movements  are  present,  the  patient  is 
subject  to  fits  of  some  kind  (either  epileptic,  hysterical  or 
uraemic  in  an  adult,  or  convulsions  of  infants). 

Fits. 

I,  EPILEPTIC  FITS.— The  distinguishing  features  of  these 
fits  are  convulsive  movements  and  unconsciousness.  An  epileptic 
fit  begins  by  the  patient  suddenly  falling  unconscious,  with 
strained  and  rigid  muscles ;  as  he  is  seized  he  may  utter  a  sharp, 
shrill  cry  or  yell.  This  stage  of  rigidity  is  then  succeeded  by 


2i4  PASTORAL   MEDICINE. 

a  stage  of  convulsions  in  which  the  patient's  body  is  thrown 
into  violent  twitchings  and  contortions  with  foaming  at  the 
mouth.  During  this  stage  the  tongue  may  be  bitten.  After 
the  patient  has  been  in  the  convulsive  stage  for  a  few  minutes, 
he  may  at  once  regain  his  consciousness  or  he  may  be  more 
or  less  confused  for  a  time,  or  more  frequently  he  becomes 
drowsy  and  passes  into  a  deep  sleep  or  stupor,  which  may  last 
several  hours. 

TREATMENT. — During  the  convulsive  stage  place  the  patient 
in  a  safe  place  to  prevent  him  from  hurting  himself;  put  a  piece 
of  wood  or  other  hard  substance  well  padded  between  his  teeth  to 
prevent  him  from  biting  his  tongue,  loosen  all  tight  clothing 
about  the  neck,  chest  and  abdomen,  and  do  not  attempt  to  restrain 
the  convulsive  movements  or  to  administer  anything  by  the 
mouth. 

After  the  convulsive  stage  has  passed  off  and  the  patient  seems 
drowsy,  encourage  natural  sleep.  If  on  waking  he  seems  ex- 
hausted, give  him  a  little  soup  or  beef  tea,  but  do  not  give  stimu- 
lants. 

2,  HYSTERICAL  FITS. — These  occur  more  often  in  females 
than  males  and  are  ushered  in  with  crying,  sobbing  or  laughing 
without  any  cause;  then  follow  jerky  movements  of  the  limbs 
(not   truly    convulsions),    at    the    same    time    the    breathing    is 
quickened,  the  eyelids  are  closed,  and  in  severe  attacks  the  patient 
falls  down  apparently  but  not  actually  unconscious,  taking  care 
never  to  hurt  herself. 

TREATMENT. — The  best  treatment  for  hysterical  patients  is  to 
exclude  all  fussy  friends  and  let  them  alone.  The  patient  will 
come  to  herself  when  she  realizes  that  her  condition  is  exciting 
no  sympathy  or  alarm. 

3,  THE  CONVULSIONS  OF  INFANTS.— These  are  usually 
caused  by  teething,  constipation,  indigestion,  worms,  etc.,  but  they 
may  be  due  to  fever  or  brain  disease. 

Symptoms. — Just  before  the  occurrence  of  a  fit  the  child  is 
usually  peevish  and  fretful.  During  the  fit  the  body  first 
becomes  stiff,  the  pulse  is  rapid  and  weak,  the  breathing  is 
hurried,  the  skin  is  wet  with  a  cold,  clammy  perspiration,  and 
there  is  complete  loss  of  consciousness.  The  rigidity  of  the 
body  lasts  a  few  seconds,  and  is  succeeded  by  a  stage  of  convul- 
sive movements  in  which  the  muscles  of  the  face  twitch  and 
the  limbs  jerk  violently.  As  one  fit  passes  off  another  may 


BURNS,  SCALDS,  ETC.  215 

supervene,  or  the  child  may  pass  into  a  semi-comatose  condition 
and  then  into  a  natural  sound  sleep. 

TREATMENT. — The  course  to  adopt  is  to  relieve  as  quickly  as 
possible  the  cerebral  circulation,  therefore  place  the  child  at 
once  in  a  bath  as  warm  as  can  be  borne  comfortably  from  ten  to 
twenty  minutes,  or  put  the  feet  in  hot  water  with  mustard  in  it; 
at  the  same  time  apply  cold  sponges  to  the  head  and  quickly 
change  them,  and  send  for  medical  assistance. 

4,  UR^MIC  CONVULSIONS.— In  the  course  of  Bright's 
disease  convulsions  and  unconsciousness  may  occur. 

TREATMENT. — The  course  to  adopt  here  is  to  encourage  the 
action  of  the  skin,  therefore  place  the  patient  in  bed  between 
warm  blankets,  pack  hot  water  bottles  round  him,  and  send  for 
medical  assistance. 

VII. — BURNS  AND  SCALDS  AND  THEIR  IMMEDIATE 
TREATMENT;  ELECTRIC  SHOCK  AND  ITS  IMME- 
DIATE  TREATMENT;    THE    REMOVAL    OF 
FOREIGN    BODIES   FROM   THE    EYE, 
EAR,   AND   NOSE. 

Burns  and  Scalds. 

BURNS  are  caused  by  the  application  of  a  fire  or  dry  heat. 

SCALDS  are  caused  by  the  application  of  hot  liquids  or  moist 
heat. 

Burns  are  divided  into  the  following  degrees,  according  to  the 
extent  of  injury  inflicted,  viz.: — 

ist  degree.— A  mere  reddening  of  the  skin. 

2nd  degree. — The  formation  of  blisters. 

3rd  degree.— Charring  and  destruction  of  tissues. 

In  addition  to  the  actual  damage  caused  by  burns  and  scalds 
there  is  also  present : — 

(i,)  Shock  to  the  System.— This  is  in  direct  proportion  to  tl 
superficial    extent   of   the   burn.     Burns   of   the   abdomen   and 
chest   are   especially   liable   to   produce   marked   shock,   and 
children  suffering  from  burns  and  scalds  the  shock  is  usually 

profound. 

(ii,)  Congestion  of  Internal  Organs.-Tbis  usually  comes  o 

after  the  shock. 


216  PASTORAL   MEDICINE. 

TREATMENT. — In  the  management  of  burns  and  scalds  the 
following  points  have  to  be  borne  in  mind : — 

(a,)  The  local  injury. 

(&,)  The  shock  to  the  system. 

If  the  shock  is  severe  it  should  be  treated  first,  and  the  local 
injury  afterwards,  when  reaction  has  set  in. 

The  Local  Injury. — In  attending  to  a  burn  care  should  be 
taken  that  the  clothing  is  removed  with  the  utmost  care  from 
the  burnt  part,  and  that  no  blisters  are  broken  in  removing  it. 
The  clothing  should  therefore  be  cut  off,  and  if  parts  adhere  to 
the  body  they  should  be  gently  removed  after  first  soaking  them 
in  oil ;  if  this  is  not  sufficient,  the  part  should  first  be  immersed 
in  a  bath  of  warm  water.  If  the  burns  are  extensive  only  one  portion 
of  the  body  should  be  dressed  at  a  time,  the  rest  being  kept 
covered  up. 

To  dress  the  Burns  proceed  as  follows:  either  apply  over 
the  burnt  parts  pieces  of  lint  which  have  been  soaked  in  carron 
oil  (a  mixture  consisting  of  equal  parts  of  linseed  oil  and  lime- 
water),  or  in  carbolic  oil,  I  in  40,  or  in  a  saturated  solution  of 
common  washing  soda,  or  spread  boracic  acid  ointment  (which 
has  been  diluted  with  an  equal  part  of  vaseline)  upon  pieces  of 
lint  and  apply  it  to  the  burnt  parts. 

Note. — Strong  antiseptics  for  dressing  burns  should  be  avoided, 
and  the  dressings  should  not  be  changed  too  often. 

BURNS  FROM  ACIDS.— First  drench  the  parts  with  water, 
wash  them  with  a  solution  made  by  dissolving  washing  soda  in 
water,  and  then  treat  as  for  an  ordinary  burn. 

BURNS  FROM  ALKALIES.— Drench  the  parts  first  with 
water,  then  wash  with  a  solution  of  dilute  vinegar  and  water,  and 
finally  treat  as  for  an  ordinary  burn. 

TO  EXTINGUISH  THE  FLAMES  FROM  BURNING 
CLOTHING. — Throw  the  person  down  whose  clothes  are  on  fire, 
and  cover  him  up  as  quickly  as  possible  with  a  rug,  coat,  shawl, 
blanket  or  other  article  of  covering. 

Shock  by  Electricity. 

This  may  be  produced  by : — 
(i,)  Natural  Electricity. — As  lightning. 

(ii,)  Artificial  Electricity — As  currents  from  telegraph,  tele- 
phone, electric  lighting  and  motor  wires. 


SHOCK   BY   ELECTRICITY.  217 

NATURAL  ELECTRICITY.— The  effects  of  lightning  vary 
according  to  circumstances ;  there  may  be  only  slight  shock  with 
dizziness,  or  there  may  be  violent  convulsions,  insensibility  or  im- 
mediate death. 

ARTIFICIAL  ELECTRICITY.— The  danger  of  a  current  of 
electricity  is  in  proportion  to  its  intensity — thus,  the  low  tension 
currents  of  the  telephone  and  telegraph  wires  would  probably 
only  produce  slight  shock,  while  the  high  tension  currents  (and 
especially  the  alternating  ones),  for  lighting  and  motor  purposes 
are  extremely  dangerous. 

The  current  from  a  dynamo  may  be  10,000  volts,  for  arc  lamps 
the  current  is  usually  2,400  volts,  and  for  lighting  (in  houses) 
100  volts. 

A  current  of  100  volts  would  be  very  dangerous,  a  current  of 
from  20  to  30  volts  is  as  much  as  can  be  comfortably  borne  by 
a  strong  man. 

When  electric  wires  have  a  current  passing  through  them, 
they  are  termed  live  wires,  and  it  is  from  these  that  there  is 
danger,  as  they  may  be  exposed  either  by  accident  or  for 
repairs. 

Symptoms. — A  person  taking  hold  of  naked  live  wires  (».  e., 
those  that  are  not  covered  with  an  insulating  material),  with  a 
current  of  high  tension  passing  through  them,  would  most  likely 
be  violently  convulsed  and  be  unable  to  let  go,  or  there  might  be 
insensibility  with  suspended  animation  or  even  death.  Parts 
of  the  body  or  clothes  in  contact  with  the  wires  may  be  scorched 
or  burnt. 

TREATMENT. — Here  proceed  as  follows : — 

(i,)  Remove  the  sufferer  from  the  source  of  danger;  this  must 
be  done  with  the  greatest  care,  or  the  person  giving  assistance 
may  himself  receive  the  shock  and  be  rendered  incapable^ 

"  When  the  injured  person  retains  his  hold  of  the  wire,  it  is 
dangerous  to  touch  any  part  of  him,  even  the  parts  of  the  body 
covered  by  clothes."  A  case  of  this  kind  is  recorded  in  the 
Electrical  Review— "While  a  man  was  cleaning  an  electric 
street  lamp  in  Boston,  he  received  a  shock  and  was  killed,  his 
body  being  suspended  from  the  wires;  a  man  who  endeavored 
to  remove  the  body  came  in  contact  with  the  current  and  was 
dashed  to  the  ground  with  such  violence  that  he  died  shortly 

afterwards."  .       . 

Therefore  before  removing  the  sufferer,  first  protect  the  hands 


2i8  PASTORAL   MEDICINE. 

whenever  possible  with  india-rubber  gloves  (these  are  used  in 
electrical  works  and  may  be  at  hand),  if  these  can  not  be  pro- 
cured, first  wrap  a  mackintosh  coat  or  a  thick  dry  woolen  cloth 
coat,  or  other  dry  article  of  clothing  round  the  patient  (damp 
articles  of  clothing  are  good  conductors  of  electricity,  and  the 
sufferer's  own  clothes  may  be  damp  from  perspiration),  and  then 
pull  the  sufferer  away  from  the  source  of  danger. 

(ii,)  Send  at  once  for  medical  assistance,  but  in  the  mean- 
while place  the  patient  in  a  comfortable  position,  loosen  all 
tight  clothing  round  the  body,  and  if  there  is  any  difficulty  with 
the  breathing  begin  at  once  to  perform  artificial  respiration. 

Two  live  naked  wires  of  which  the  sufferer  may  have  hold, 
may  be  short  circuited  by  dropping  (not  placing,  as  then  the 
assistant  might  get  the  shock),  an  iron  bar  or  other  metallic 
tool  across  them,  in  this  way  carrying  the  current  from  one  wire 
to  the  other  instead  of  through  the  body  of  the  sufferer. 

Removal  of  Foreign  Bodies. 

1.  FROM  THE  EYE.— Foreign  bodies  may  be  removed  from 
the  surface  of  the  eye  as  follows.     If  under  the  upper  lid,  first 
evert  the  lid  by  placing  a  bodkin  or  match  over  it,  and  then 
gently  pull  the  lid  over;  in  this  way  the  whole  of  the  upper 
surface  of  the  conjunctiva  is  exposed  and  may  be  very  gently 
swept  over  with  a  camel's  hair  brush,  or  with  a  piece  of  soft 
linen  dipped  in  warm  water. 

If  under  lower  lid,  the  whole  of  the  conjunctiva  under  the 
lower  lid  may  be  exposed  by  gently  pulling  the  eyelid  down  with 
a  finger,  and  the  foreign  body  removed  as  described  above. 

2.  FROM  THE  EAR.— Great  care  should  be  taken  in  these 
cases  not  to  poke  any  sharp  instruments  into  the  ear,   as  the 
drum  might  easily  be  injured;  warm  glycerine  or  oil   may  be 
poured   into   the  ear  and  the   organ  gently   syringed   out  with 
warm  soapy  water. 

3.  FROM  THE  NOSE.— The  nose  should  either  be  blown 
forcibly,  or  gently  syringed  out  with  warm  water,  or  the  patient 
may  be  made  to  sniff  pepper  and  sneeze. 


TRANSPORT  OF  SICK  OR  INJURED.      tig 

VIII. — THE  TRANSPORT  OF   SICK   AND 
INJURED. 

THE  POSITION  OF  SICK  OR  INJURED  PERSONS 
DURING  TRANSPORT.— Patients  may  be  removed  in  any  of 

the  following  positions: — 

i.— The  Sitting  Position.— This  is  to  be  adopted  for  patients 
who  are  slightly  injured  in  the  upper  part  of  the  body,  and  are 
without  constitutional  symptoms. 

2. — The  Semi-Recumbent  Position. — This  is  to  be  adopted  for 
those  who  are  injured  about  the  region  of  the  chest,  and  are 
suffering  more  or  less  from  shortness  of  breathing. 

3. — The  Recumbent  Position. — This  is  to  be  adopted  in  all 
cases  where  persons  have  been  dangerously  injured  about  the 
head,  chest  or  abdomen,  also  in  fractures  of  the  long  bones, 
injuries  to  joints  of  the  lower  extremity,  and  in  cases  of  faint- 
ness,  shock  and  excessive  hemorrhage. 

Note. — Before  a  patient  is  removed,  the  necessary  "  First  Aid  " 
treatment  should  always  be  rendered,  and  the  clothes  about  the 
chest  should  be  Loosened. 

Preparation  for  the  Reception  of  a  Case  of  Accident 
or  Sudden  Illness. 

While  engaged  in  attending  to  a  case  of  accident  or  sudden 
illness,  if  possible,  send  a  messenger  to  the  patient's  house,  in 
order  that  arrangements  may  be  made  for  his  reception. 

i.  SELECTION  AND  PREPARATION  OF  THE  ROOM. 

(i,)  Selection  of  the  Room.— The  points  to  attend  to  are: 
that  the  room  should  be  easily  accessible,  it  should  be  large  and 
lofty  with  a  south  or  southwest  aspect,  the  windows  should 
admit  sufficient  light,  and  should  be  made  to  open  top  and 
bottom,  and  there  should  be  a  fireplace  with  a  chimney  that  does 
not  smoke. 

(ii,)  Preparation  of  the  Room.— The  room  should  be  thoroughly 
cleansed  (if  time  will  permit  of  it),  well  ventilated  by  drawing 
down  the  top  windows,  a  fire  should  be  lighted  in  it,  it  should 


220  PASTORAL   MEDICINE. 

be  warmed  to  a  temperature  of  60°  Fahr.  and  maintained  at 
this,  a  thermometer  being  hung  in  the  room  for  the  purpose  of 
regulating  the  temperature;  the  carpet  and  all  superfluous  furni- 
ture should  be  removed  from  the  room. 

2.  THE  BEDSTEAD  AND  BED. 

(i,)  The  Bedstead. — Wide  bedsteads  are  to  be  avoided,  as  the 
patient  can  not  be  easily  got  at ;  the  best  kind  of  bedstead  to 
use  is  an  iron  one,  3  to  3^  feet  wide  by  6l/2  feet  long,  it  should 
be  placed  away  from  the  wall  (so  that  it  can  be  approached  from 
either  side),  and  if  possible  across  the  room  between  the  door 
and  fireplace  with  the  head  facing  the  window. 

(ii,)  The  Bed. — Feather  beds  and  flock  mattresses  are  to  be 
avoided,  hair  mattresses  are  the  best;  the  bed  clothes  should  be 
light  and  warm,  no  vallances  or  curtains  should  be  used,  and 
care  should  be  taken  that  the  space  under  the  bedstead  is  vacant. 

The  bed  should  be  made  and  the  bed  clothes  well  turned 
down,  two  stout  chairs  should  be  placed  next  to  the  bed,  on 
which  to  rest  the  stretcher  while  the  patient  is  being  undressed. 
It  may  (in  cases  where  the  injuries  are  severe,  or  mud-stained 
clothes  have  to  be  removed  or  extensive  dressings  applied),  be 
necessary  to  have  a  second  bed  or  couch  in  the  room  on  which 
to  first  lay  the  patient.  Extra  blankets  and  hot  water  bottles 
should  be  kept  in  readiness. 

In  cases  of  collapse  the  blankets  should  be  made  hot  and 
flannel  should  be  wrapped  round  the  hot  water  bottles. 

If  there  is  any  likelihood  of  the  bedclothes  being  soiled,  i.  e., 
in  cases  of  extensive  injury,  or  where  dressings  have  to  be 
applied,  or  where  the  patient  is  unconscious  or  extremely  weak 
and  passes  his  evacuations  under  him,  a  draw-sheet  should  be 
placed  on  the  bed. 

TO  PUT  ON  A  DRAW-SHEET— proceed  as  follows:— 

Procure  a  large  cotton  sheet,  fold  it  lengthways  into  four  and 
place  it  across  the  bed  so  that  it  will  reach  from  just  below  the 
patient's  shoulders  to  his  knees,  now  place  a  piece  of  mackintosh 
between  the  draw-sheet  and  the  under  sheet,  the  draw-sheet 
being  about  4  inches  wider  than  the  mackintosh ;  one  end  of  the 
draw-sheet  is  tucked  in  under  the  mattress,  the  other  end  is 
rolled  up  on  the  opposite  side  of  the  bed ;  when  the  part  of  the 
draw-sheet  under  the  patient  becomes  soiled  it  is  withdrawn  a 
little  to  one  side  by  being  rolled  up  a  little  more. 

In  cases  of  fracture  where  the  patient  will  have  to  lie  in  bed 


TRANSPORT  OF  SICK  OR  INJURED.      221 

for  several  weeks,  it  is  important  to  have  a  properly  arranged 
bed — termed  a  "fracture  bed." 

THE  ESSENTIALS  OF  A  "FRACTURE  BED"  ARE:— 
(i,)  That  there  should  be  no  sagging  or  giving  way; 
(ii,)  That  the  surface  should  be  evenly  smooth  and  comfort- 
ably elastic; 

(iii,)  That  the  foot  of  the  mattress  should  be  a  little  higher 
than  the  head. 

The  best  way  to  arrange  a  fracture  bed  is  as  follows:  first 
place  a  straw  palliasse  on  the  bedstead,  then  on  the  palliasse 
place  two  horsehair  mattresses  3^  to  4  inches  thick,  and  on  the 
top  mattress  one  blanket;  to  raise  the  bedstead  place  a  thin 
board  under  the  legs  at  the  foot. 

In  fracture  of  the  lower  extremity  or  of  the  spine,  there 
should  be  no  bolsters  or  pillows  for  the  head,  but  only  a  thin 
cushion,  and  boards  should  be  placed  across  the  bed  under  the 
mattress. 

A  cradle  to  take  off  the  weight  of  the  bed  clothes  may  be 
necessary  in  fracture  of  the  lower  extremity,  or  sprain  of  the 
ankle  joint;  for  a  cradle,  a  cardboard  box  with  the  ends  cut 
out,  or  a  three-legged  stool,  may  be  used. 

3.  CARRYING    THE    PATIENT    UPSTAIRS    TO    HIS 
ROOM. 

Before  removing  the  patient  to  his  room,  the  hall  and  staircase 
should  be  cleared  so  as  to  allow  sufficient  room  for  those  carrying 
him  to  pass. 

The  particular  method  to  be  adopted  for  carrying  will  depend 
in  each  case  upon  the  nature  and  extent  of  the  injury,  and  the 
condition  of  the  patient. 

A  patient  may  be  carried  upstairs  by— 
(i,)  A  single  bearer. 
(ii,)  By  two  bearers. 

(iii,)  On  a  stretcher.  Here  the  head  should  go  first,  and  the 
stretcher  should  be  carried  in  the  same  manner  as  is  laid  down 
for  carrying  stretchers  when  loading  wagons,  the  two  bearers 
at  the  foot  should  take  care  to  keep  the  stretcher  as  nearly  hori- 
zontal as  possible  by  raising  it,  or 

(iv,)  By  placing  the  patient  in  a  strong  chair  and  carrying 
him  up  backwards,  while  a  third  person  walks  after  the  chair, 
helps  to  support  it,  and  prevents  the  patient  from  falling  out. 

4.  REMOVING  THE  CLOTHES.— Before  putting  the  patient 


222  PASTORAL   MEDICINE. 

to  bed  the  clothes  should  be  first  removed,  and  great  care  should 
be  taken  in  doing  this ;  in  serious  cases  it  is  better  to  remove  the 
clothes  by  cutting  them  away. 

In  removing  a  coat  from  an  injured  arm,  draw  out  the  un- 
injured arm  first,  and  in  putting  on  anything  put  the  injured 
arm  in  first. 

In  removing  trousers  from  an  injured  limb  rip  up  the  outside 
seam. 

In  removing  clothing  in  cases  of  burns  and  scalds,  cut  away 
the  parts  which  are  not  adhering,  and  soak  the  adhering  parts 
well  with  oil  before  removing  them. 

5.  LIFTING  THE   PATIENT   INTO   BED.— This  may  be 
done  as  follows : 

(i,)  If  the  bed  is  narrow  and  there  is  room  for  the  stretcher, 
place  it  on  the  floor  with  the  head  close  to  the  foot  of  the  bed, 
three  bearers  can  then  lift  the  patient  head  foremost  over  the  foot 
of  the  bed. 

(ii,)  If  the  bed  is  wide,  place  the  stretcher  close  alongside  the 
bed,  the  patient's  head  corresponding  to  that  of  the  bed.  Nos.  I, 
2  and  3  bearers  place  themselves  on  the  far  side  of  the  stretcher, 
and  No.  4  bearer  on  the  near  side ;  the  patient  is  then  lifted  and 
supported  on  the  knees  of  Nos.  i,  2  and  3  bearers,  No.  4  bearer 
pulls  away  the  stretcher  and  stands  aside,  while  the  other  bearers 
lift  the  patient,  stand  up,  and  place  him  in  position  on  the  bed. 

6.  PREPARATION  FOR  SURGEON'S  VISIT.— When  sum- 
moning a  doctor,  inform  him  as  far  as  possible  of  the  nature  of 
the  case  so  that  he  may  come  prepared. 

The  following  should  be  in  readiness: — 

Plenty  of  hot  and  cold  water,  clean  towels  and  soa'p,  and  a 
receptacle  for  dirty  water. 

For  Burns  and  Scalds. — A  good  supply  of  clean  old  linen, 
cotton  wool,  olive  oil,  "  carron  "  oil  and  bandages. 

For  Hemorrhage. — Ice,  sponges  and  plenty  of  water. 

For  Drowning. — Plenty  of  blankets  heated  before  the  fire  and 
several  hot  water  bottles,  the  sheets  from  the  bed  should  also  be 
removed. 

If  poultices  and  fomentations  are  required,  plenty  of  boiling 
water,  linseed  meal,  mustard,  a  small  basin,  a  large  spoon, 
olive  oil,  tow,  flannel,  a  kitchen  roller  and  two  sticks  or  a  large 
towel. 


Appendix. 
THE  MOMENT  OF  DEATH. 

BY  THE  REV.    WALTER   M.   DRUM,   S.  J. 

COME  of  the  leading  authorities  in  medical  science 
^  now  consider  it  an  established  truth  that  the  mo- 
ment of  death  is  later  than  it  is  commonly  supposed  to 
be.  Fr.  Ferreres  SJ.  asked  the  Catholic  medical 
society,  Academia  de  los  Santos  Cosme  y  Damidn,  of 
Barcelona,  to  give  him  its  opinion  on  the  differences 
between  real  and  apparent  death,  and  last  year  published, 
in  Razon  y  Fe,1  the  answer  of  that  learned  society  and 
the  result  of  his  own  study.  We  are  indebted  to  him 
for  most  of  our  data. 

The  question  of  the  moment  of  death  has  always  been 
of  importance  to  the  moral  theologian;  for  while  there 
is  life  in  the  body,  there  is  a  soul  of  a  wayfarer  to  be  lost 
or  to  be  saved,  there  is  a  chance  to  turn  a  human  soul 
from  the  road  to  hell  and  set  it  on  the  way  to  heaven. 
According  to  the  common  opinion  of  moral  theo- 
logians, no  matter  how  likely  is  the  presence  of  death,  the 
least  probability  of  the  presence  of  life  makes  it  lawful 
that  the  saving  sacraments  be  administered  to  a  dying 
man;  for  the  probability  of  life  means  a  possibility  of 
salvation,  and  man  has  a  right  to  that  which  is  necessary 
for  his  salvation.  Sacramento,  sunt  propter  homines,  non 
homines  propter  sacramental 

1Cf.  "La  Muerte  Real  y  la  Muerte  Aparente  con  Relacion  a 
los  Santos  Sacramentos,"  by  J.  B.  Ferreres,  S.  J.,  in  Razon  y  Fe 
for  January,  February,  March  and  May,  1904. 

'Cf.  St.  Alphonsus,  L.  6,  n.  124;  Busembaum,  S.  J.,  De  Bap- 
tismo,  Dubium  4,  Resp.  4;  Gury,  S.  J.,  Compend.  2,  247;  Bal- 
lerini,  S.  J.-Palmieri,  S.  J.,  4,  75i. 

223 


224  PASTORAL    MEDICINE. 

Lehmkuhl,  S.  J.3  says  we  should  administer  the  sacra- 
nents  if  there  be  any  doubt  whatsoever,  be  it  never  so 
small,  in  favor  of  the  subject's  being  alive  and  in  proper 
dispositions. 

Villada,  S.  J.*  considers  that,  for  six  minutes  after 
what  seems  to  be  the  moment  of  death,  there  is  a  doubt  in 
favor  of  the  presence  of  life  and  the  sacraments  may  be 
administered.  Noldin,  S.  J.  and  Alberti  have  the  same 
view. 

Genicot,  S.  J.5  holds  that  the  sacraments  must  be  ad- 
ministered if  the  priest  arrives  just  after  the  breath, 
pulse-beats  and  heart-beats  have  ceased.  Unless  there 
be  fear  of  contempt  of  the  sacrament  by  the  bystanders, 
he  would  have  Extreme  Unction  given  to  a  man  who  has 
just  died. 

In  Palmieri's  Ballerini,6  we  find  it  set  down  that  the 
slenderest  hope  of  the  validity  of  the  sacrament  is 
enough  to  make  it  our  duty  to  administer  that  sacrament 
to  a  dying  man. 

Bucceroni,  S.  J.,  La  Croix,  S.  J.,  Marc  and  others  may 
be  cited  in  favor  of  this  common  opinion  of  moralists. 
Their  view  is  summed  up  in  the  Instruction  of  Eichstadt : 
"It  is  better  to  expose  a  sacrament  to  the  danger  of 
invalidity,  than  man  to  the  danger  of  eternal  damnation. " 

We  leave  out  all  question  of  those  who  are  known  to 
live ;  we  speak  only  of  those  whose  death  is  apparent  but 
not  certain,  whose  life  may  have,  and  yet  probably  has 
not  come  to  an  end.  We  also  leave  out  all  question  of 
administering  the  sacraments  absolutely;  for  the  absolute 
administering  of  a  sacrament  requires  a  moral  certainty 

*  Cf.  Lehmkuhl,  2,  n.  273. 

4  Cf.  Villada,  Casus  3,  244. 

*  Cf.  Genicot,  2,  422. 
•Cf.  Ball-Palm.  5,  238. 


THE  MOMENT  OF  DEATH.  225 

that  the  subject  lives  and  is  in  proper  dispositions.  Our 
question  is  only  about  the  administration  of  the  sacra- 
ments conditionally,— i.  e.,  on  the  condition  that  the  sub- 
ject be  alive  and  be  in  proper  dispositions.  This  condition 
is  not,  of  course,  to  be  expressed  in  the  formula  of  ad- 
ministration unless  the  rubrics  call  for  such  expression. 

To  make  clear  to  every  one  the  importance  of  knowing 
the  moment  of  death,  we  give  five  cases  of  those  that  may 
be  apparently  dead,  and  may,  in  the  state  of  latent  life, 
be  brought  unto  eternal  salvation: 

First.     An  infant  unbaptized.  , 

Second.  An  adult,  unbaptized,  who  never  has  had  the 
use  of  reason. 

Third.  An  adult,  unbaptized,  who  has  had  the  use  of 
reason,  but  has  never  made  an  act  of  perfect  love  of  God, 
is  not  in  mortal  sin,  and  has  given  some  sign  of  a  wish 
to  be  saved. 

Fourth.  An  adult,  unbaptized,  who  has  had  the  use 
of  reason,  has  made  an  act  of  perfect  love  of  God,  and 
then  has  committed  mortal  sin  for  which  he  has  attrition 
but  not  contrition,  and  has  given  a  sign  of  a  wish  to  be 
saved. 

Fifth.  An  adult,  baptized,  who  has  committed  mortal 
sin  for  which  he  has  attrition  but  n^c  contrition,  and 
whose  life  leads  one  to  suppose  that  if  he  knew  the  need 
and  could  ask  for  absolution  he  would  certainly  ask. 

The  possibility  of  these  five  cases  must  be  admitted  by 
all.  Where  there  is  need  of  acts  of  attrition  and  of  inten- 
tion to  receive  the  sacraments,  these  acts  may  at  times  be 
not  only  past  and  not  retracted,  but  even  actual.  In  cases 
of  latent  life  the  subject  may  have  clear  thought  and 
full  deliberation.  The  presence  of  a  priest  may  arouse 
him  to  proper  disposition.  It  is  the  experience  of  physi- 
cians that  now  and  then  the  cerebrum  is  free  and  thought 


226  PASTORAL    MEDICINE. 

and  will  are  unimpeded,  while  there  is  complete  paralysis 
of  the  cerebellum  and  those  parts  of  the  nervous  system 
that  control  muscular  action. 

In  the  first  case,  baptism  is  the  only  means  to  salva- 
tion. Without  baptism  that  infant  will  not  go  to  the  hell 
of  the  damned,  nor  yet  will  it  ever  see  God. 

In  the  second  case,  the  adult  is,  practically  speaking,  an 
infant ;  his  soul  can  not  enter  heaven  unless  washed  with 
the  waters  of  baptism. 

In  the  third  case,  baptism  may  be  administered  condi- 
tionally, and  without  it  the  man's  soul  may  not  be  saved. 

In  the  fourth  case,  the  man's  soul  is  ticketed  to  hell, 
and  baptism  is  the  only  sacrament,  the  only  means  to 
save  him  from  hell. 

In  the  fifth  case,  conditional  absolution  or  extreme 
unction  is  necessary  to  keep  the  soul  from  eternal  tor- 
ture.7 Attrition  without  a  sacrament  will  not  save  this 
soul  from  hell. 

From  a  consideration  of  these  five  cases,  we  may  con- 
clude how  very  important  it  is  not  only  for  the  clergy, 
but  also  for  the  laity,  to  know  that  the  moment  of  death 
is  generally  later  than  it  is  supposed  to  be.  Time  and 
again  it  happens  that  death  has  not  yet  come  to  the  body 
which  seems  a  lifeless  corpse,  and  the  conditional  ad- 
ministration of  a  sacrament  by  us  is,  in  God's  providence, 
the  only  possible  means  of  saving  for  the  enjoyment  of 
heaven  a  soul  that  otherwise  would  be  kept  from  the 
beatific  vision  forever. 

What,  then,  is  the  moment  of  death  ?  After  the  receipt 
of  the  query  of  Fr.  Ferreres,  the  Academia  de  los  Santos 
Cosme  y  Damian  considered  our  question  in  the  society's 
four  sessions  of  January  8th,  I5th,  22d,  and  29th,  1903. 

TCf.  C.  Pesch,  7,  538;  Suarez,  De  Extrema  Unctione,  d.  41, 
§  i,  n.  15;  Ballerini-Palmieri,  5,  861. 


THE  MOMENT  OF  DEATH.  227 

Eminent  physicians  entered  into  the  discussion.  The 
conclusion  was  reached  that  no  one  really  dies  at  the 
moment  which  is  ordinarily  considered  his  last,  but  death 
comes  some  time  later. 

Fr.  Ferreres  sets  down  this  thesis :  "Between  the  mo- 
ment of  death,  commonly  so  called,  and  the  instant  at 
which  death  really  takes  place,  it  is  probable  that  there 
is  always  a  period  of  latent  life  during  which  the  sacra- 
ments may  be  administered." 

Let  us  first  consider  the  case  of  the  new-born  child. 
It  is  now  the  common  opinion  of  theologians  that  the 
human  fetus  is,  from  its  conception,  endowed  with  a  soul. 
God  creates  the  soul  and  unites  it  to  the  body  at  the 
very  moment  of  conception.  From  that  very  moment 
the  fetus  is  capable  of  salvation  and  of  baptism.  The 
prematurely  ejected  fetus  and  the  still-born  child  should 
be  baptized  conditionally,  so  long  as  there  is  a  probability 
of  life. 

How  long  is  there  a  probability  of  life  in  the  fetus 
that  is  born  before  its  time?  The  pastoral  Instruction  of 
Eichstadt  answers,  "So  long  as  there  is  no  corruption  nor 
certain  sign  of  death."  Eschbach8  tells  us  to  baptize  the 
fetus  absolutely  if  there  be  in  it  the  slightest  motion,  and 
conditionally  if  there  be  in  it  no  motion,  nor  yet  any  cor- 
ruption. Berardi9  lays  down  a  similar  rule. 

This  wise  rule  is  in  keeping  with  the  experience  of 
physicians.  The  child  of  premature  birth  has  often  given 
signs  of  life  after  it  seemed  for  many  hours  to  be  dead. 
Dr.  Grau  y  Marti  speaks  of  a  fetus  in  which  a  slight  pal- 
pitation was  marked  twenty-three  hours  after  apparent 
death  had  begun.  Dr.  Ruiz  Contreres  brought  back  to 
life  a  child  born  in  its  seventh  month  and  abandoned  for 

'  Cf.  "  Quaest.  Physiol.-Theol.,"  d.  III.,  p.  2,  c.  3,  a.  3- 
*Cf.  "Praxis  Confess.,"  III.,  845,  846. 


228  PASTORAL    MEDICINE. 

dead,  put  it  in  an  incubator  and  kept  it  alive  a  day  or 
two.  Dr.  Goodell  reported  to  the  Gynecological  Society 
of  Chicago  the  remarkable  case  of  a  physician  who  made 
every  effort  to  bring  three  infants  back  to  life,  left  them 
for  dead,  returned  next  day  to  bury  them  and  found 
them  alive.  Icard  exclaims:  "How  many  babies  have 
been  left  for  dead,  and  later  found  alive  by  those  that 
intended  to  bury  them !" 

From  these  facts  we  may  learn  several  practical  les- 
sons. Physicians  should  do  all  in  their  power  to  bring  to 
life  children  that  seem  to  be  still-born  yet  give  no  sign  of 
putrefaction.  Laborde,  in  his  work,  "Les  Tractions 
Rhythmees  de  la  Langue,"  gives  the  testimony  of  many 
physicians  to  show  that  numerous  children  have  been 
given  up  for  dead  who  might  have  been  saved  to  life  if 
proper  efforts  had  been  made.  The  faithful  should  be 
made  to  understand  that,  unless  it  be  certain  putrefac- 
tion has  set  in,  the  still-born  child  (be  it  never  so  imma- 
ture) should  invariably  be  baptized  sub  conditione.  Very 
many  souls  may  in  this  wise  be  saved  to  life  eternal. 

Doctors  should  learn  to  baptize  in  case  of  premature 
birth.  If  the  fetus  be  still  enveloped  in  the  secundine, 
and  too  immature  even  for  the  possibility  of  incubating, 
it  is  to  be  baptized  in  that  state.  But  there  is  great  like- 
lihood that  the  after-birth  is  not  part  of  the  child.  The 
first  baptism  is  not  certain ;  hence  the  doctor  should  bap- 
tize a  second  time  and  sub  conditione.  He  should  im- 
merse the  fetus  in  water,  tear  open  the  secundine  with 
his  fingers,  pronounce  the  formula  ("If  thou  art  alive 
and  art  not  baptized,  I  baptize  thee,"  etc.),  and  withdraw 
the  fetus  at  once.10 

If  there  is  a  period  of  latent  life  in  the  delicate  organ- 

"Cf.  Eschbach,  321;  Capellmann  "Medicina  Pastoralis,"  112. 


THE  MOMENT  OF  DEATH.  229 

ism  of  the  child  that  is  born  before  its  time,  there  is  such 
a  period  also  in  the  stronger  organism  of  the  dying  adult. 
How  long  does  this  period  of  latent  life  last?  When 
does  death  begin  ?  When  do  the  organs  of  the  adult  cease 
to  live  ?  These  questions  have  not  yet  been  satisfactorily 
answered  by  men  of  science. 

Even  in  the  seventeenth  century,  Dr.  Thomassini 
wished  the  first  twelve  hours  after  apparent  death  to  be 
considered  as  a  continuation  of  life.  Laborde  thinks  no 
doctor  can  be  certain  of  the  presence  of  death  till  he  has 
used  the  rhythmic  tractions  of  the  tongue  for  three  hours. 
All  agree  that  there  is  a  period  of  latent  life  even  when 
the  whole  organism  is  wasted  away  by  lingering  disease. 
The  length  of  this  period  is  variously  estimated.  Dr. 
Coutenot  puts  this  length  at  an  hour ;  Dr.  Blanc,  at  from 
two  to  six  hours;  Capellmann,  at  one  to  twenty-four 
hours;  Surbled,  at  more  than  three  hours;  Icard,  at  six 
to  twelve  hours. 

We  are  no  surer  of  the  moment  of  death  than  were  the 
scientists  of  two  hundred  years  ago.  In  the  eighteenth 
century  the  Benedictine  Fr.  Feijoo  said :  "No  one  knows 
what  is  the  soul's  last  influence  on  the  body,  nor  in  what 
precise  condition  the  body  must  be  in  order  to  preserve  its 
union  with  the  soul.  Hence  it  is  impossible  to  know  just 
when  a  man  dies.  Let  us  take  a  body  that  has  so  wasted 
away  as  to  seem  utterly  lifeless ;  let  it  be  without  respira- 
tion, without  color,  without  feeling,  without  motion.  We 
can  be  certain  of  only  one  thing  about  this  body.  There 
is  in  it  no  perceptible  soul-influence.  But  what  is  to  make 
us  sure  that  in  some  one  or  other  of  the  internal  organs 
the  soul  does  not  perform  some  function  or  other?  You 
tell  me  that  life  comes  to  an  end  when  the  blood  ceases 
to  flow  and  the  heart  ceases  to  beat.  I  ask  you  how  you 
know  this.  You  can  be  sure  of  no  such  thing  unless  by 


230  PASTORAL    MEDICINE. 

divine  or  angelic  revelation.  All  we  can  be  certain  of  is 
the  absence  of  any  vital  action  that  may  be  perceived  by 
the  senses."  "  The  learned  monk  of  scholastic  days  also 
tells  us  that  the  blood  may  circulate  so  slowly  and  the 
heart  may  beat  so  softly  as  to  suffice  for  life,  yet  not  for 
our  observation.  In  this  idea  he  agrees  with  old  Galen, 
who  centuries  ago  suggested  that  there  could  be  a  beating 
of  the  heart  and  a  respiration  so  slight  as  not  to  be  notice- 
able, yet  strong  enough  to  keep  life  up  awhile.  Galen 
and  Feijoo  were  not  far  from  the  truth;  we  are  very 
little,  if  at  all  nearer. 

Icard  claims  that  life  ends  when  the  heart  stops  beat- 
ing, but  allows  of  only  two  ways  of  finding  out  with  cer- 
tainty that  the  heart  does  not  beat.  Either  the  heart 
must  be  laid  bare  or  a  long  delicate  needle  must  be  pushed 
through  the  body  to  the  heart.  The  eye  will  correct  the 
error  of  the  ear,  and  will  observe  either  the  palpitation  of 
the  heart  laid  bare  or  the  registration  of  such  palpitation 
by  the  needle.  Any  one  whose  latent  life  is  discovered 
by  either  of  the  above  methods  is  not  likely  to  outlive  the 
discovery  many  minutes. 

Drs.  Coutenot,  Laborde  and  Blanc,  and  the  majority  of 
the  members  of  the  Barcelona  Academy  do  not  agree 
with  Dr.  Icard,  and  insist  that  the  soul  may  exist  in  the 
body  without  exerting  the  greater  vital  functions.  Our 
own  Dr.  Keane  is  said  to  have  succeeded,  by  heart-mas- 
sage, in  renewing  palpitation  two  hours  after  the  heart 
had  ceased  to  beat. 

This  dispute  between  Dr.  Icard  and  others  is  theoretical 
rather  than  practical.  All  admit  it  is  practically  impos- 
sible to  tell  the  exact  time  at  which  the  heart  stops  beat- 
ing. Icard  says  there  are  many  clinical  proofs  that  the 

uCf.  "Senales  de  la  Muerte  Actual,"  252. 


THE  MOMENT  OF  DEATH.  231 

heart  may  perform  its  function  so  gently  that  the  most 
experienced  ear  can  not,  by  auscultation,  note  any  sound 
at  all.  He  cites  cases  in  which  physicians  tried  a  whole 
hour  and  failed  either  to  hear  a  heart-beat  or  to  observe 
any  respiration ;  yet,  on  opening  up  the  breast,  they  found 
the  heart  still  beating  and  the  subject  still  alive. 

Various  other  signs  of  death  are  mentioned  by  physi- 
cians, but  these  signs  do  not  give  any  certainty.  The 
livid  spots  that  appear  on  the  body  may  be  due  to  as- 
phyxia.12 The  change  of  countenance  may  be  a  result  of 
sudden  irregularity  in  the  heart-beats.  Even  the  rigidity 
of  the  body  is  no  certain  sign  of  the  presence  of  death.  It 
precedes  the  death  of  those  attacked  by  spasms,  lockjaw 
and  asphyxia. 

The  Paris  Academy  of  Medicine  offered  a  prize  to  the 
one  who  would  find  some  other  sign  of  death  besides  the 
rigidity  and  decomposition  of  the  corpse.  One  hundred 
and  two  papers  were  handed  in.  None  gave  satisfaction ; 
all  proposed  signs  which  did,  indeed,  seem  to  prove  that 
the  greater  functions  were  at  an  end,  but  did  not  prove 
that  the  lesser  functions  had  ceased. 

We  prefer  to  follow  such  a  Catholic  and  scientific  so- 
ciety as  the  Academia  de  los  Santos  Cosme  y  Damidn, 
rather  than  the  view  of  one  or  two  physicians,  on  this 
important  question.  We  say,  with  Icard,  that  it  is  ex- 
ceedingly difficult  to  tell  just  when  the  greater  functions 
of  respiration  and  circulation  come  to  an  end.  The  time- 
honored  tests  of  the  candle  or  mirror  placed  near  the  nose 
or  mouth  are  of  little  importance  nowadays.  We  go  even 
farther  than  Icard  and  follow,  as  a  fairly  probable 
opinion,  the  unanimous  judgment  of  the  above-named 
academy,  that  there  is  really  no  certain  and  universal 

12  Cf.  Capellman,  183. 


PASTORAL    MEDICINE. 

sign  of  death  other  than  decomposition  of  the  whole  body, 
and  in  a  somewhat  advanced  stage.  Decomposition  that 
has  just  set  in  is  not  a  sure  sign  of  real  death ;  such  de- 
composition may  come  from  gangrene  that  precedes 
death. 

Death  is  not  as  sudden  as  it  sometimes  seems  to  be. 
The  separation  of  soul  from  body  is  a  slow  and  violent 
process.  Death  takes  its  grim  hold  on  the  human  organs, 
not  all  at  once  but  step  by  step.  Most  physicians  now 
agree  that  the  greater  functions,  such  as  respiration  and 
circulation,  first  cease ;  then  there  comes  a  period  of  latent 
life  that  varies  in  length  according  to  the  cause  which 
brings  death.  During  this  period  of  latent  life  the  func- 
tional properties  of  the  tissues  and  organic  elements  re- 
main, but  without  external  manifestation  of  their  pres- 
ence ;  if  these  functional  properties  are  put  into  action  by 
outside  force,  the  greater  of  the  vital  functions  may  at 
times  be  fully  restored.18 

How  is  it  life  clings  to  man  even  after  the  greater  func- 
tions of  respiration  and  circulation  have  ceased  ?  Because 
an  organ  continues  to  live  so  long  as  its  cells  and  tissues 
are  not  incapacitated  for  their  specific  organic  function 
and  retain  the  various  elements  necessary  for  nutrition. 
Of  course,  without  the  greater  functions  of  circulation 
and  respiration,  the  supply  of  oxygen  and  other  nutritive 
elements  is  cut  off  from  the  cells  and  tissues ;  yet,  accord- 
ing to  many  physicians,  the  cells  and  tissues  may  go  on 
living  for  a  while,  even  after  their  supply  of  nutrition  is 
cut  off.  By  what  means  do  the  cells  and  tissues  live 

M  Cf.  Capellmann,  178.  This  is  also  Laborde's  explanation.  We 
have  submitted  this  paper  to  several  eminent  physicians;  among 
them  was  Dr.  J.  Taber  Johnson,  vice-president  of  the  Medical 
School  of  Georgetown  University.  They  considered  our  argu- 
ment was  sound,  our  conclusion  probable  and  our  medical  au- 
thorities good. 


THE  MOMENT  OF  DEATH.  233 

without  new  fuel?  By  virtue  of  the  nutritive  elements 
which  past  respiration  and  circulation  have  stored  up. 
The  more  hale  and  hearty  are  the  organs,  the  longer  will 
they  last  on  their  organic  reserve-store  of  nutritive  en- 
ergy, the  longer  will  the  time  of  latent  life  be.  Healthy 
cells  and  tissues  do  not  break  down  so  readily  as  do  sickly 
cells  and  tissues.  The  state  of  apparent  death  lasts  longer 
in  cases  of  a  sudden,  than  in  cases  of  long  expected 
death.  During  a  long  and  painful  sickness,  every  organ, 
tissue  and  cell  has  been  gradually  yet  constantly  weak- 
ened, and  has  been  so  impoverished  as  to  have  drained 
out  almost  completely  that  reserve-supply  of  nutrition 
which  is  always  stored  up  within  healthy  organs,  tissues 
and  cells.  The  period  of  latent  life  is  very  short  after 
such  draining  and  impoverishment  of  the  system;  when 
the  greater  functions  cease,  when  the  lungs  refuse  to  sup- 
ply oxygen  and  the  blood  no  longer  carries  nutrition  to 
the  cells,  life  comes  to  a  speedy  end,  the  cells  and  tissues 
have  no  reserve-supply  to  fall  back  upon. 

This  lengthy  explanation  is  not  a  mere  fancy,  nor  a 
theory  that  is  not  borne  out  by  facts.  We  appeal  to  the 
facts  we  have  given  about  infants.  We  add  more  facts 
that  go  to  show  how  doubtful  is  the  presence  of  death 
until  decomposition  has  reached  an  advanced  stage. 

First  we  give  some  facts  of  sudden  death.  Professor 
Wetz/of  the  Catholic  University  of  Lisle,  gives  several 
cases  of  return  to  life  after  one  and  one-half  to  three 
hours  of  apparent  death  caused  by  lightning.  Laborde 
for  three  hours  applied  his  system  of  rhythmic  tractions 
of  the  tongue,  and  brought  to  perfect  health  a  person 
who  had  been  ten  minutes  under  water  and  was  given  up 
for  dead.  Sorre  in  this  way  saved  one  who  had  been  an 
hour  under  water.  Laborde  gives  189  cases  in  which 
rhythmic  tractions  of  the  tongue  revived  those  who 


234  PASTORAL    MEDICINE. 

seemed  to  have  been  killed  by  strangulation,  asphyxiation 
and  other  forms  of  suffocation.  Dr.  Blanc  says  there  are 
numerous  cases  of  wounded  soldiers  who  were  restored 
to  life  after  they  had  been  from  two  to  twelve  days  in 
the  state  of  apparent  death  from  hemorrhage. 

These  cases  of  sudden  death  should  suffice  to  prove 
our  point.  We  shall  add  a  few  cases  of  lingering  death. 
Even  in  regard  to  the  man  who  seems  to  have  died  after 
a  long  sickness,  Dr.  Icard  gives  this  wise  advice:  "It 
is  better  far  to  treat  a  dead  man  as  if  he  were  alive  than 
to  treat  a  live  man  as  if  he  were  dead."  Dr.  Icard  gives 
such  advice  to  the  prudent  physician  of  the  body.  May 
not  the  prudent  physician  of  the  soul  be  right  in  always 
doubting  the  presence  of  death  ? 

Now  for  our  examples  of  lingering  death.  Dr.  Cirera 
tells  of  a  woman  who  seemed  to  have  died  from  pneumo- 
nia and  pericarditis.  After  fifteen  minutes  of  artificial 
respiration  the  heart-beats  were  again  perceived;  after 
two  hours  the  woman  had  regained  the  use  of  her  senses ; 
she  died  twenty-four  hours  later. 

Dr.  Coriton  gives  the  case  of  a  woman  who  was  found 
livid,  stiff,  without  respiration  or  palpitation.  She  was 
said  to  have  died  from  some  tracheo-bronchial  affection. 
The  rhythmic  tractions  of  the  tongue  were  applied  at  the 
rate  of  thirty-five  to  forty  per  minute.  All  pallor  first 
disappeared  from  the  cheeks,  then  from  the  nostrils; 
later  on  there  was  a  slight  movement  of  the  nostrils ;  after 
five  minutes  a  soft  sigh  was  heard;  after  half  an  hour 
pulsation  and  respiration  were  regular;  the  woman  lived 
three  months  more. 

The  facts  and  authorities  we  have  given  prove,  with  at 
least  some  probability,  that  there  is  a  period  of  latent  life 
between  the  apparent  and  real  moment  of  death  of  every 
man.  Not  on  our  own  authority,  but  on  the  authority  of 


THE  MOMENT  OF  DEATH.  235 

Fr.  Ferreres  and  the  physicians  and  theologians  already 
cited,  we  hold  that  it  is  fairly  probable  that  we  can  never 
be  sure  this  period  of  latent  life  is  ended  till  total  decom- 
position has  reached  an  advanced  stage.  So  long  as  we 
have  any  doubt  about  the  presence  of  total  decomposition, 
it  is  probable  that  we  should  administer  conditionally  the 
sacraments  which  may  be  the  only  possible  means  of 
bringing  the  subject  to  heaven. 


THE  FIFTH  COMMANDMENT. 

I.   ABORTION.1 

TT  was  reserved  for  Christian  civilization  to  prohibit 
*•  artificial  abortioning  for  therapeutic  purposes  and 
to  abolish  it  almost  wholly,  until,  toward  the  close  of  the 
last  century,  the  English  achieved  the  very  doubtful 
honor  of  reintroducing  abortion  among  obstetric  opera- 
tions. The  French  followed  suit,  so  did  the  Germans 
after  prolonged  opposition.  Jaquemier*  wrote,  in  1867: 
"To-day,  where  there  is  no  longer  a  hesitation  to  interrupt 
in  its  first  stages  a  gravidity  which  can  not  run  its  course 
without  jeopardizing  the  life  of  the  woman  in  labor,  no 
physician  worthy  of  his  name  would  consent  to  remain 
voluntarily  an  inactive  witness."  The  operation  has  been 
reintroduced  in  Germany  by  Menden,  Kiwisch  and  Scan- 
zoni.  Owing  to  their  influence,  nearly  all  the  teachers  of 
obstetrics,  and  writers  thereon,  cite  one  or  the  other  occa- 
sion, sometimes  quite  many,  where  artificial  abortion  is 
indicated. 

Abortion  is  the  bringing  forth  of  the  fetus  before  its 
maturity.  Not  being  developed  sufficiently  to  live  in- 
dependently from  the  womb,  the  fetus  is  doomed  to  cer- 

1  In  these  chapters  we  reproduce,  in  addition  to  the  matter  on 
this  subject  in  the  Second  Part,  page  86  of  this  work,  the  state- 
ments of  Dr.  Capellmann,  one  of  the  most  frequently  quoted 
authorities  on  these  practical  questions.  Those  who  wish  to 
study  this  subject  more  thoroughly  will  find  all  arguments  in 
favor  of  abortion  ably  answered  and  refuted  by  Van  Oppenray, 
S.J.,  in  "The  Right  to  Life  of  the  Unborn  Child"  (New  York: 
Wagner). 

1  Jaquemier,  in :  Dictionnaire  Encyclopedique  des  Sciences  Medi- 
cales.  Paris,  1867.  Volume  VII.,  575. 

236 


ABORTION.  237 

tain  death;  hence  the  direct  effect  of  abortion  is  the 
death  of  the  fetus.  Artificial  abortion  is  tantamount  to 
killing  the  fetus. 

In  order  to  judge  rightly  the  question  whether  abortion 
in  obstetrics  be  permissible,  it  is  necessary  to  determine 
what  is  the  nature  of  the  object  in  the  abortion.  This 
object  is  the  impregnated  ovum  of  the  human  female  in 
the  state  of  being  developed.  The  fetus  must  be  sup- 
posed to  be  alive  until  the  contrary  is  sufficiently 
proven.  That  a  dead  fetus  may  be  brought  forth  goes 
without  saying.  However,  it  is  very  difficult,  in  most 
instances  impossible,  to  determine  positively  whether  the 
fetus  is  dead  or  alive  at  the  time  of  gravidity.  Hence 
we  have  to  suppose  that  the  fetus  is  alive.  In  such  case, 
however,  it  is  endowed  with  a  human  soul.  The  homo- 
geneous human  soul  is  the  vital  principle  for  the  animal 
life  of  man.  And  there  is  no  reason  to  suppose  that  the 
fetus  has  a  specific  vital  principle,  a  specific  soul,  up 
to  delivery  or  to  a  certain  stage  of  the  gravidity,  the  ra- 
tional human  soul  then  to  take  its  place,  qua  cedente  as  St. 
Thomas  opines.1 

An  absence  of  a  rational  soul  pending  the  life  in  the 
womb  can  not  be  construed  from  the  lack  of  the  higher 
functions  of  the  soul  or  of  their  manifestation.  The  rea- 
son thereof  is,  for  one,  that  the  perceptive  and  active  or- 
gans of  the  embryo  are  not  developed,  or  are  prevented 
from  working.  This  is  by  no  means  an  isolated  instance. 
In  a  like  manner  we  see  how,  in  a  quiet  sleep,  in  a  swoon, 

1 "  Quaestiones  disputatae,  quaestio  unica  de  anima  art.  9. 
Et  sie  quum  in  embryone  primo  sit  anima  vegetativa  tantum, 
quum  perventum  fuerit  (sc.  ab  embryone)  ad  majorrm  perfec- 
tionem,  tollitur  forma  imperfecta  et  succedit  forma  perfectwr 
quae  est  anima  vegetativa  et  sensitiva  simul,  et  ulttma  cedente 
succedit  ultima  forma  completissima,  qua  est  amma  rahonahs. 


238  PASTORAL    MEDICINE. 

or  in  apparent  death,  animal  life  continues  to  functionate, 
although  the  higher  actions  of  the  soul  are  suspended,  or 
at  least  seem  suspended.  It  is  not  necessary  for  the  soul 
to  be  ever  active  in  all  directions ;  at  most  we  may  deduce 
from  the  non-manifestation  of  some  actions  of  the  soul, 
that  the  proper  conditions  for  their  exercise  are  lacking. 
Hence  the  want  of  higher  activities  of  the  soul  is  no 
proof  for  the  non-presence  of  a  rational  soul ;  therefore  we 
assume  that  the  human  embryo  at  the  moment  of  im- 
pregnation becomes  endowed  with  a  rational  human  soul, 
and  that  the  impregnated  human  embryo  is  an  inde- 
pendent human  being. 

Every  human  being — the  impregnated  human  embryo, 
too — has,  first  of  all,  the  right  to  live.  This  right  is 
inalienable,  provided  ( i )  the  person  has  not  forfeited  the 
same  by  acting  contrary  to  divine  and  human  laws,  and 
by  transgressing  natural  and  social  order;  or,  unless  (2) 
in  case  of  assault  the  assaulted  acquires  the  right  to  in- 
flict, in  self-defense,  bodily  injury  upon  the  aggressor; 
he  may  even  kill  him  to  preserve  his  own  life. 

Ad  ( i )  The  child  in  the  womb  can  not  forfeit  its  right 
of  existence  by  acting  contrary  to  law,  or  by  transgressing 
the  ruling  order,  because  it  is  by  force  in  a  wholly  passive 
state.  No  one  can  merit  punishment  by  remaining  pas- 
sive, or  by  inaction,  if  he  is  debarred  from  acting  without 
fault  of  his  own. 

Ad  (2)  Nor  can  it  be  argued  that  the  fetus  is  commit- 
ting an  assault  against  the  life  of  its  mother.  Without  any 
of  its  own  doing,  without  any  act  or  volition  of  its  own, 
the  child  has  been  brought  into  a  position  where  it  event- 
ually may  endanger  the  mother's  life.  Hence  we  can  not 
speak  of  an  unjust  assault.  The  qualification  "unjust" 
is,  however,  essentially  necessary  for  making  the  killing 
in  self-defense  permissible.  But  even  if  the  child  can  not 


ABORTION.  839 

be  born  without  imperiling  the  life  of  its  mother,  it  is 
more  than  doubtful  whether  the  child  can  be  regarded 
as  committing  the  assault.  In  by  far  the  largest  number 
of  cases  the  impediment  is  caused  by  the  mother;  for 
instance,  by  a  too  narrow  pelvis,  etc.  Besides,  the  act  of 
giving  birth  has  not  its  origin  with  the  child,  but  with 
the  mother.  The  danger  for  mother  and  child  comes 
from  the  action  of  the  womb,  which,  while  not  controlled 
by  the  mother's  will-power,  emanates  from  her,  pertains 
to  her.  Hence,  if  by  a  voluntary  act  on  the  part  of  the 
mother,  by  procreation,  the  child  without  any  of  its  own 
doing  has  been  placed  within  the  mother's  womb;  if 
the  dislodgment  of  the  child  from  the  uterus  is  aimed  at 
by  an  activity  emanating  from  the  mother ;  if,  finally,  this 
dislodgment  is  disturbed  or  prevented  through  impedi- 
ments due  to  the  mother,  as  it  is  in  most  cases ;  and  if  all 
these  circumstances,  all  dut  to  the  mother,  tend  to  jeop- 
ardize the  lives  of  mother  and  child,  can  any  one  possessed 
of  a  particle  of  justice  maintain  that  the  child  has  com- 
mitted an  unjust  assault  or  even  an  assault?  Hence  the 
mother,  or  the  physician  acting  in  her  behalf,  has  not  the 
excuse  of  self-defense  on  her  or  his  side.  Therefore  arti- 
ficial abortion  is  to  be  looked  upon  as  an  unjustifiable 
homicide;  it  is  tantamount  to  murder. 

Murder  is  prohibited  by  every  divine  and  human  law. 
Hence  the  artificial  abortion  is  prohibited.1  The  ques- 
tion is,  whether  there  are  circumstances  that  make  the  arti- 
ficial abortion  permissible.  Here  we  must  make  a  two- 
fold distinction. 

1  Some  women  who  have  been  impregnated  outside  of  wedlock 
expect  from  the  physician  to  save  them  from  dishonor  by  pro- 
voking an  abortion.  It  goes  absolutely  without  saying  that  the 
physician  must  not  do  it.  There  are  some  physicians  who  ad- 
vise not  to  refuse  the  imputation,  lest  the  person  refused  may 


240  PASTORAL    MEDICINE. 

i.  Is  it  permissible  to  cause  directly  the  artificial  abor- 
tion, in  order  to  rescue  the  mother's  life  from  danger? 
2.  Is  it  permissible  to  cause  indirectly  the  artificial  abor- 
tion, to  put  the  life  of  the  mother  thereby  out  of  danger  ? 

The  answer  of  the  moralists  is,  "Nunquam  licet  directe 
procurare  abortum."  Even  the  intention  to  preserve  the 
life  of  the  mother  does  not  make  the  direct  abortion  per- 
missible. It  will  not  do  to  plead  the  welfare  of  the  mother 
as  directly  intended,  the  abortion  only  indirectly ;  it  mat- 
ters, what  is  being  done.  With  the  exception  of  a  single 
case  (stated  below),  the  mother  is  only  removed  out  of 
danger  after  and  because  of  the  abortion  having  taken 
place.  Hence  the  saving  of  the  mother  is  not  directly 
and  immediately  due  to  the  medicine  which  started  the 
abortion,  and  which  may  have  been  indifferent  in  itself, 
but  it  is  only  due  to  and  caused  by  the  abortion.  Now, 
a  good  effect  directly  intended,  must  not  have  been  caused 
by  a  forbidden  effect,  for  in  that  case  the  forbidden  effect 
must  necessarily  have  been  intended. 

Abortion  would  be  brought  about  indirectly  by  the 
use  of  remedies  which  are  either  necessary  or  apt  to  ward 
off  the  danger  for  the  mother,  but  which  probably,  or 
likely,  cause  the  not-intended  abortion.  It  is,  no  doubt, 
permissible  to  use  proper  and  safe  remedies  for  a 
good  purpose,  even  if  they  may  produce  a  second  for- 
bidden but  not  intended  effect,  on  the  condition  that 
the  directly  intended  good  effect  is  in  proportion  to  the 
loss  or  damage  caused  by  the  forbidden  effect;  that  the 
means  used  are  apt  to  directly  and  immediately  cause 

find  the  sought-for  help  elsewhere.  They  advise  to  seemingly 
grant  the  request,  but  to  prescribe  some  indifferent  medicine,  put- 
ting her  off  in  that  manner.  Aside  of  the  fact  that  this  trick 
will  mostly  fail  in  its  purpose,  I  hold  such  an  apparent  consent 
to  a  criminal  plan  to  be  morally  unallowable,  and  at  any  rate 
most  unworthy. 


ABORTION. 


241 


the  good  effect,  not,  however,  that  the  good  effect  has  its 
cause  in  the  forbidden  effect  simultaneously  brought 
about  with  it;  that  another  means  to  achieve  the  good 
effect  does  not  exist  or  is  not  known;  finally,  that  the 
utmost  is  done  to  prevent  the  forbidden  effect. 

Hence  in  treating  the  pregnant,  even  in  the  absence  of 
any  urgent  danger,  the  use  is  allowed  (see  Gury,  tract,  de 
V.  402)  of  means  and  remedies  which,  according  to  med- 
ical science,  are  necessary  for  the  cure  of  the  mother,  or 
which  have  at  least  a  healing  tendency.  Their  use  is  al- 
lowed, albeit  they  may  be  known  to  sometimes  cause  abor- 
tion. But  this  effect  must  not  be  a  necessary  sequel  of 
the  medicine,  but  rather  a  rare  instance.  Against  the 
probable  or  certain  cure  of  the  mother  as  effected  by  that 
remedy,  is  to  be  taken  in  account  an  only  possible  endan- 
gering of  the  fetus;  the  directly  intended  good  effect  is 
therefore  adequate  to  the  possibly  arising  subsequent 
evil  effect.  In  this  category  belong  all  medicines  if  ad- 
ministered in  regular  therapeutical  doses,  also  bathing, 
bleeding,  injections  into  the  genitals,  and  so  on.  As  a 
matter  of  course,  the  remedies,  whether  for  internal  or 
external  use,  must  be  given  in  such  quantities  only  as  are 
absolutely  necessary  for  the  cure  of  the  mother,  and  the 
administering  persons  should  feel  themselves  bound  to 
prevent  abortion  as  far  as  possible. 

Should  the  mother  be  in  direct  and  immediate  danger 
of  death,  then  a  treatment  directly  and  immediately  sav- 
ing her  life  may  be  adopted,  although  expected  to  cause 
abortion.  This  would  be  permissible,  however,  only  in 
default  of  any  other  saving  means,  and  only  if  the  utmost 
care  be  taken  to  prevent  abortion.  As  I  have  proved  in 
my  treatise1  neither  of  the  aforesaid  conditions  apply  to 

1"De  Occisione  Foetus." 


» 
24*  PASTORAL    MEDICINE. 

any  of  the  cases,  with  but  a  single  exception,  in  which 
the  obstetricians  of  our  day  perceive  a  necessity  for  pro- 
voking abortion.  The  one  condition  especially  is  never 
fulfilled :  that  the  rescue  of  the  mother  be  directly  due  to 
the  remedy  given.  The  rescue  of  the  mother  would  in  all 
cases  only  be  resultant  from  the  removal  of  the  fetus,  the 
interruption  of  pregnancy;  hence  it  could  not  be  main- 
tained that  the  abortion  was  brought  about  indirectly. 
On  the  contrary,  the  means  of  saving  the  mother  would 
be  found  in  nothing  else  but  the  abortion  itself ;  hence  the 
latter  would  have  been  directly  employed  as  a  means, 
which  is  prohibited. 

Here  I  cannot  possibly  coincide  with  Lehmkuhl  *  when 
he  says,  in  his  early  editions  (III.,  841)  :  Ex  consulto 
abort  tint  inducere,  etiam  licere  videtur  in  PRAESENTI  z-itae 
mater nae  discritnine,  quod  per  solam  foetus  immaturi  in- 
jectionem  averti  possit:  quo  in  casu  vix  magis  erit 
DIRECTA  abortus  procuratio  sensu  theologico,  quam  in 
jiaufragio  tabulam  amico  cedere  est  directa  sui  ipsius  oc- 
cisio.  (Eodem  modo  si  ejectio  foetus  necessaria  esset  ad 
ejus  baptismum,  hacc  indirecta  occisio,  sen  potius  mortis 
acceleratio,  videretur  esse:  sed  id  vix  unquam  occurrerit.) 

The  explanation  as  given  by  Lehmkuhl  in  this  sentence 
fails  to  make  the  matter  clear.  In  cases  of  pressing 
danger  for  the  mother,  he  pleads  for  the  abortion, 
which  he  disclaims  to  be  in  the  nature  of  a  direct  one, 
yet  his  arguments  fairly  apply  to  the  latter.  To  begin 
with,  the  roundabout  way  of  speaking  of  abortion,  telling 
us  that  the  mother  laxatis  fibris  foetum  ex  utero  elabi 
sinat,  atque  ita  perire  permittat.  Yet  he  himself  takes 
issue  with  that  view,  because  the  provoked  abortion  re- 

1  "Theologia  Moralis."  Auctore  Augustino  Lehmkuhl.  Friburgi 
Brisgoviae.  Sumptibus  Herder,  1883. 


ABORTION.  243 

quires  something  else,  a  perturbatio  conditions  naturalis 
and  a  violentia.  And  then,  on  second  thought,  he  shifts 
the  question  to  an  altogether  different  point:  the  fetus' 
control  over  its  own  life  and  its  will  to  sacrifice  its  own 
life  for  the  sake  of  its  mother  are  pressed  into  service. 
He  says  r1  Foetus,  "potest  renuntiare  in  favorem  mater- 
nae  vitae;"  this  will  remain,  necessarily,  unproved. 
2.  Foetus,  "REVERA  RENUNTIARE  DICENDUS  EST,  quia  in 
illis  circunistantiis  jus  illud  sibi  evadit  inutile,  quippe  quod 
a  certa  morte  se  non  defendat,  imo  si  ad  supernaturalem 
finem  respicimus,  aggravat  periculum  SINE  BAPTISMO  de- 
cedendi,  qui,  abortu  secuto,  foetui  applicare  potest."  By 
what  right  are  we  to  assume  that  the  fetus  wants  to  re- 
nounce anything? 

As  to  the  christening  of  the  fetus,  after  the  abortion  has 
taken  place,  it  is  a  matter  of  experience  that  the  fetus  sur- 
vives the  provoked  abortion  only  in  rare  instances.  In 
rejoinder  to  the  closing  sentence  (I.,  c.  844)  :  "Modo 
tamen  post  foetus  immaturi  ejectionem  baptismi  con- 
ferendi  saltern  aeque  certa  sit  spes,  atque  esset,  si  terminus 
naturae  exspectaretur"  it  is  to  be  remarked,  that  there  are 
greater  chances  for  a  valid  christening  at  the  end  of 
gravidity  than  after  abortion,  for  the  reason,  already  men- 
tioned, that  the  fetus,  after  being  produced  prematurely, 
will  be  rarely  found  alive,  even  in  the  case  of  a  quick  abor- 
tion, which,  moreover,  can  but  seldom  be  brought  about. 
How  Olfers  (Pastoral  Medicine,  p.  15)  can  claim  the 
reverse  to  be  a  fact  I  can  not  comprehend.  I  wonder  how 
many  fetuses  post  abortum  he  has  seen  alive? 

In  regard  to  those  cases  where  the  immediate  danger 
to  the  mother  is  due  to  some  other  malady  we  may  add 
that  the  chances  of  saving  the  mother  by  bringing  about 
the  abortion  are  by  no  means  great.  Abortion  can  not 


244  PASTORAL    MEDICINE. 

be  effected  within  a  short  time,  it  often  takes  several 
days;  besides,  artificial  abortion  itself  is  not  without  its 
dangers  to  a  woman,  especially  in  the  critical  condition 
caused  by  some  other  illness. 

I  cling  to  the  axiom  subscribed  to  without  dissension  by 
all  moralists :  "Nunquam  licet  directe  procurare  abor- 
tum."  If  it  is  only  the  abortion  (ejectio  foetus},  which 
removes  the  danger  of  life,  it  follows  that  the  abortion, 
the  evil  effect,  precedes  and  causes  the  good  effect.  It  is 
impossible  to  call  this  an  indirect  abortion. 

The  .rules  under  which  the  indirect  abortion  is  permis- 
sible, coincide,  to  my  mind,  in  but  one  single  instance — 
when  the  pregnant  womb  becomes  irremovably  com- 
pressed into  the  small  pelvis,  as  may  happen  by  bending 
backward,  prolapsing  or  inclining  the  gravid  womb.  If 
in  this  case  all  other  means  known  to  science  for  the  re- 
placing or  releasing  of  the  womb  have  been  tried  and 
have  failed,  then  I  hold  it  permissible  l  to  indirectly  bring 
about  abortion  by  puncturing  the^amnion  and  draining  off 
the  fluid  contained  therein.  My  reasons  therefor  are : 

1.  The  mother's  life  is  in  immediate  danger ;  but  for  a 
reposition  of  the  uterus  she  and  the  fetus  are  bound  to 
perish. 

2.  This  is  the  only  remedy  left. 

3.  The  draining  off  of  the  amniotic  fluid  is  apt  to  re- 
move the  danger  immediately.  In  this  case  the  danger 
for  the  mother  does  not  lie  in  her  pregnancy,  in  the  physio- 
logical sense,  but  in  a  purely  mechanical  cause,  to  wit: 
the  enlargement  of  the  womb.    By  draining  the  amnion 

1  Some  theologians  are  taking  exception  even  to  this  case  of 
indirect  abortion.  Cappellmann  seems  to  be  supported  in  his 
view  by  some  authorities;  by  Antonelli,  for  instance.  His  argu- 
ments, however,  should  be  judged  in  the  light  of  Van  Oppenray's 
statements  in  "  The  Right  to  Life  of  the  Unborn  Child." 


MYOMA.  245 

of  its  fluid,  the  uterus  is  made  to  shrink,  the  mechanical 
obstacle  to  the  reposition  of  the  womb  is  removed,  and 
the  mother  thereby  placed  out  of  immediate  danger,  and 
before  the  abortion,  which,  indeed,  is  bound  to  follow,  has 
been  brought  about.  A  necessity  for  resorting  to  a  real 
abortion,  the  artificial  ejection  of  the  fetus  from  the  womb, 
is  not  present.  Happily,  the  compression  of  the  womb  does 
not,  in  itself,  occur  very  frequently ;  moreover,  the  cases 
where  a  reposition  is  absolutely  impossible  are  so  rare 
that  Professor  Martin,  of  Berlin,  in  fifty-seven  cases, 
had  but  once  occasion  to  take  recourse  to  the  puncturing 
of  the  amnion.  Of  the  fifty-seven  cases,  fifty  were  righted 
by  reposition,  five  abortioned  spontaneously,  with  subse- 
quent reposition.  The  remaining  case  was  that  of  a 
woman  who,  having  made  an  unsuccessful  attempt  at  let- 
ting off  the  fluid,  went  to  the  hospital  in  a  critical  condi- 
tion and  died  without  reposition.  The  woman  that  had 
been  punctured  by  Professor  Martin  died  likewise. 

II.    MYOMA. 

Within  the  past  decade  there  has  been  frequently  per- 
formed an  operation  which,  being  virtually  an  indirect 
abortion,  ought  to  be  noted  here.  I  refer  to  the  supra- 
vaginal  operation  of  the  gravid  uterus  because  of  Myoma. 
The  growth  of  the  myoms  during  pregnancy  is  at  times 
such  as  to  threaten  imminently  and  directly  the  life  of  the 
mother.  Some  of  these  myoms  cannot  be  removed  even 
by  laparotomy  unless  the  uterus  be  removed  with  them. 
The  extirpation  of  the  diseased  womb  is  apt  to  save  the 
patient.  Here,  too,  the  danger  was  not  caused  by 
pregnancy,  but  by  the  growth  in  the  uterus.  It  is 
true  that  with  the  removal  of  the  uterus  the  fetus 
also  is  removed.  Simultaneously  with  removing  the 


246  PASTORAL    MEDICINE. 

danger  from  the  mother  an  abortion  takes  place,  if  one 
wants  to  put  it  that  way ;  however,  the  abortion  was  not 
necessary  to  remove  the  danger.  But  all  doubts,  misgiv- 
ings and  difficulties  that  may  hitherto  have  existed  are 
removed  for  the  Roman  Catholic  through  the  decision  of 
the  Holy  Office  of  July  24,  1895,  which  is,  in  the  words 
of  Lehmkuhl,  "ejusmodi  invasionem  in  vitale  foetus 
elementum  craniotomiae  aequiparat  atque  pro  directa 
occisione  habet  proin  pro  re  intrinsecits  illicita." 

In  the  eighth  edition  of  his  "Theologia  Moralis "  Lehm- 
kuhl retracts  his  former  opinion,  citing  the  text  of  the 
decisions  from  "Analecta  Ecclesiastica,"  vol.  iii.,  page 
480,  thus: 

"Stephanus  Maria  Alphonsus  Sonnois,  Archiep.  Cam- 
eracensis,  ad  pedes  Sanctitatis  Tuae  devotissime  provo- 
lutus,  quae  sequuntur  humiliter  exponit.  Titius  medicus, 
quum  ad  praegnantem  graviter  decumbentem  vocabatur, 
passim  animadvertebat,  letalis  morbi  causam  aliam  non 
subesse  praeter  ipsam  praegnationem,  hoc  est,  foetus  in 
utero  praesentiam.  Una  igitur,  ut  matrem  a  certa  atquc 
imminenti  morte  salvaret,  praesto  ipsi  erat  via,  procu- 
randi  scilicet  abortum  seu  foetus  ejectionem.  Viam  hanc 
consueto  ipse  inibat,  adhibitis  tamen  mediis  et  operationi- 
bus,  per  se  atque  immediate  non  quidem  ad  id  tendentibus, 
ut  in  materno  sinu  foetum  occiderent,  sed  solummodo  ut 
vivus,  si  fieri  posset,  ad  lucem  ederetur,  quamvis  proxime 
moriturus,  utpote  qui  immaturus  omnino  adhuc  esset." 

Jamvero  lectis,  quae  die  19  Augusti,  1889,  Sancta 
Sedes  ad  Cameracensem  Archiepiscopum  rescripsit. 
"Tuto  doceri  non  posse  licitam  esse  quamcunque  opera- 
tionem  directe  occisivam  foetus,  etiam  si  hoc  neces- 
sarium  foret  at  matrem  salvandam"  dubius  haeret  Titius 
circa  liceitatem  operationum  chirurgicarum,  quibus  non 
raro  ipse  abortum  hucusque  procuravit,  ut  praegnantes 


CRANIOTOMY—CESAREAN  SECTION.     247 

graviter  aegrotantes  salvaret.  Quare,  ut  conscientiae 
suae  consulat,  supplex  Titius  petit,  utrum  enuntiatas 
operationes  m  repetitis  dictis  circumstantiis  instaurare 
tuto  possit."-Fer.  iv.,  die  24  Julii,  1895.  "In  Congreg. 
gen.  S.  R.  et  univ.  Inquisitionis  proposita  supradicta  in- 
stantia  Emi  et  Rmi  DD.  Cardinales  in  rebus  fidei  et 
morum  Inquisitores  gen.,  praehabito  Rmos  D.  Consul- 
torum  voto,  respondendum  decreverunt:  Negative,  juxta 
alia  decreta,  die  scil.  28  Mai  1884  et  19  Aug.  1889.  Se- 
quenti  vero  feria  V.  die  25  Julii  in  audientia  R.  G.  P. 
adsessori  impertita  SSmus  D.  N.  relatam  Sibi  Em.  Ta- 
trum  resolutionem  adprobavit. 
L.  +  S. 

I.  MANCINI  CAN.  MAGNONI, 
S.  R.  et  Univ.  Inquisitionis  notarius." 

III.     CRANIOTOMY  AND  OTHER  OPERATIONS  UPON 

THE  CHILD  IN  THE  WOMB. 

CESAREAN  SECTION. 

The  various  operations  upon  the  child  to  bring  on  de- 
livery, such  as  perforation,  cephalotripsy,  embryotomy, 
embryothlasy  were  known,  in  part,  already  to  the  an- 
cients. Until  the  beginning  of  the  nineteenth  century, 
however,  it  had  been  the  conditio  sine  qua  non  for  the 
operation  that  the  child  was  dead,  and  was  pronounced  so 
by  experts.  Within  the  last  century,  however,  the  occi- 
sion  of  the  living  child,  also,  has  gained  ground  more  and 
more,  and  it  is  generally  recommended,  in  our  time,  in 
cases  which,  admitting  only  of  the  alternative  between 
cesarean  section  and  occision,  demand  the  delivery  of  the 
mother  who  would  not  submit  to  cesarean  section. 

Is  it  permitted  to  perforate  the  child?  Obviously  not, 
for  it  is  tantamount  to  directly  killing  the  child,  which 


248  PASTORAL    MEDICINE. 

is  always  prohibited.  Moreover,  in  an  overwhelming 
majority  of  cases,  occision  by  no  means  offers  the  only 
salvation  for  the  mother,  inasmuch  as  the  cesarean  sec- 
tion is  almost  always  feasible.  Lastly,  the  occision  is  not 
even  a  certain  expedient  for  saving  the  mother,  while  the 
child  is  surely  bound  to  perish  by  it. 

It  has  been  customary  to  look  upon  the  cesarean  sec- 
tion as  a  deadly  operation,  hence  moralists  are  prone  to 
regard  it  as  unefficacious  for  the  rescue  of  mother  and 
child.  In  former  years  those  that  died  after  or  during 
this  operation  may  have  outnumbered  those  that  sur- 
vived it;  to-day  the  reverse  is  the  case.  Statistics  show 
that  of  loo  women  which  have  undergone  the  cesarean 
section,  the  number  of  survivors  were,  according  to 
Kaiser,  38 ;  to  Michaelis,  46 ;  to  Mayer,  46 ;  to  Hermann, 
57;  to  Indes-Lacomb,  60,  and  to  Villeneuve,  69,  which 
makes  an  average  of  52.6  per  cent. 

In  addition  hereto,  it  must  be  noted  that,  according  to 
all  compilations,  the  mortality  due  to  cesarean  section  has 
been  reduced  owing  to  improvement  in  surgery  and  treat- 
ment. This  is  clearly  shown  by  a  table  prepared  by  Gar- 
imond  from  statistics  by  Kayser,  Lauth,  Gueniot  and 
Joulain.  The  percentage  of  mothers  surviving  that  opera- 
tion was : 

Per  cent. 

From  1750  to  1800 32 

From  1801  to  1832 37 

From  1832  to  1839 51 

From  1839  to  1861 60 

Undoubtedly  the  results  obtained  by  cesarean  section 
have  been  more  favorable  yet  since  the  introduction  of 
aseptic  surgery.  It  is  to  be  regretted  that  no  statistics 
on  a  larger  scale  have  been  published  on  this  subject.  Ac- 
cording to  recent  reports  from  maternity  hospitals  at 


CRANIOTOMY—CESAREAN  SECTION.     249 

Leipsic  and  Dresden  there  were  only  four  deaths  in 
twenty-four  cases,  where  the  cesarean  section  had  been 
performed  after  Saenger's  conservative-antiseptic  method. 
F.  A.  Kehrer  reports  6  death  cases  out  of  16,  while  ac- 
cording to  Leopold  there  were  out  of  23  but  2  that  did 
not  survive  the  operation;  again,  Winkel  estimates  the 
mortality  among  the  women  undergoing  the  operation 
at  8.6  and  8.4  per  cent.  Kaltenbach  even  maintains  that 
the  mortality  amounts  to  not  more  than  from  2  to  3  per 
cent,  if  the  section  is  performed  under  favorabU  external 
conditions  and  according  to  approved  surgical  and  anti- 
septic methods. 

Altogether  there  were,  according  to  the  above  figures, 
12  deaths  out  of  63 ;  hence  the  number  of  survivors  from 
the  operation  average  80  per  cent. 

Another  table,  compiled  by  Struzzi,  assistant  to  Pro- 
fessor Porro,  covers  150  cases  where  hysterotomy  was 
performed  after  Porro's  method  from  1876  to  1887, 
inclusive.  Of  these  49  died;  the  rest,  67  per  cent.,  were 
saved.  Even  these  small  figures  bear  testimony  of  a  re- 
duced mortality. 

Taking  into  further  account  the  large  proportion  of 
new-born  children  surviving  the  section,  which  accord- 
ing to  Scanzoni  amounts  to  65,  according  to  Michaelis 
and  Hermann  to  66,  to  Kaiser  to  70,  Villeneuve  to  72, 
Kehrer  to  72.5  and  to  Leopold  even  to  87  per  cent.,  we 
must  recognize  the  cesarean  section,  especially  in  view  of 
the  fatal  situation  which  renders  its  performance  neces- 
sary, as  not  only  not  deserving  the  name  of  a  savage  oper- 
ation, but  we  must  on  the  contrary  praise  it,  as  a  most 
beneficial  many-lives-saving  operation. 

On  the  other  hand,  occision,  so  much-touted,  in  contra- 
distinction to  cesarean  section,  yields  altogether  differ- 


«5°  PASTORAL    MEDICINE. 

cut  results  from  what  ought  to  be  expected  on  the  strength 
of  its  being  so  generally  recommended. 

According  to  Lee  there  died,  after  the  operation,  23  out 
of  127  mothers;  according  to  Professor  Halbertsma,  of 
Utrecht,  39  to  39.5  per  cent  died  out  of  100  mothers.  Here 
too  the  introduction  of  antiseptics  was  accompanied  with 
a  great  improvement.  The  percentage  of  women  dying 
after  perforation  is  quoted  by  Spiegelberg  and  Winckel 
to  be  17  per  cent,  respectively  14.6  per  cent ;  by  Miiller, 
of  Berne,  and  Thorn,  of  Halle,  12  per  cent. ;  Merkel,  of 
Leipsic,  8  per  cent ;  and  Wyder,  of  Berlin,  8.3  per  cent 
According  to  a  compilation  by  Kehrer  the  mortality  among 
mothers  who  underwent  perforation  was,  in  Hessia.  Nas- 
sau and  Baden  (from  1852-1888),  16.5  per  cent;  in  303 
cases  of  craniotomy,  19.8  per  cent ;  in  12  hospital  wards 
from  2.8  per  cent  to  56.5  per  cent.  Average,  14.6  per 
cent  The  mortality  among  mothers  after  perforation 
is  therefore  nearly  as  high  as  after  the  cesarean  section, 
while  by  perforation  every  one  of  the  children  perish  as  a 
matter  of  course.  According  to  the  figures  above,  the 
survivors,  after  cesarean  section,  average  150  to  170  out 
of  200;  those  surviving  perforation  average  80  to  90  out 
of  200;  balance  in  favor  of  cesarean  section,  70  to  80 
human  fives. 

While  no  claim  is  advanced  as  to  these  figures  being  ab- 
solutely correct,  yet  they  show  sufficiently  that  cesarean 
section  preserves  many  children's  lives ;  they  disprove 
the  contention  that  it  is  almost  always  deadly  for  the 
mother ;  they  show,  again,  that  the  process  of  perforation, 
which  results  in  a  sure  death  for  the  child,  offers  but  a 
limited  chance  for  saving  the  mother,  being  almost  as 
dangerous  for  her  as  the  section.  This  ought  to  con- 
demn the  occision  of  the  living  child  already  on  the 
ground  of  utility.  Hence  the  killing  of  the  child  by 


CRANIOTOMY—CESAREAN  SECTION.     251 

the  physician  cannot  be  sanctioned,  not  even  in  the  case 
where  nearly  all  obstetricians  advise  occision,  to  wit, 
when  there  is  but  an  alternative  between  section  and  per- 
foration, and  the  mother,  whose  life  depends  on  delivery, 
refuses  to  submit  to  the  section.  There  is  nothing  left 
for  the  physician  but  to  wait  for  the  death  of  either  the 
child  or  the  mother.  Not  being  able  to  avert  the  death  of 
the  latter  by  fair  means,  he  must  bide  his  time,  and  then 
use  all  his  art  in  behalf  of  the  surviving  life. 

For  the  Roman  Catholic  this  question  is  authoritatively 
decided  by  virtue  of  the  decree  by  the  Holy  Office,  ad- 
dressed to  the  Cardinal  Archbishop  of  Lyon,  which  reads 
as  follows: 

Eminentissime  et  Reverendissime  Domine: 

Eminentissimi  P.  P.  mecum  Inquisitores  Generales  in 
Congregatione  generali  habita  Feria  iv.,  die  28  labentis 
Maii,  ad  examen  revocarunt  dubium  ab  Eminentia  tua 
propositum:  "An  tuto  doceri  possit  in  scholis  catholicis, 
licitam  esse  operationem  chirurgicam  quam  cranioto- 
miam  appellant,  quando  scilicet  ea  omissa  mater  et  nlius 
perituri  sint,  ea  e  contra  admissa,  salvanda  sit  mater  in- 
fanta pereunte?"  Ac  omnibus  diu  et  mature  perpensis, 
habita  quoque  ratione  eorum  quae  hac  in  re  a  peritis 
catholicis  viris  conscripta  ac  ab  Eminentia  tua  huic  Con- 
gregatione transmissa  sunt,  respondendum  esse  duxerunt : 
Tuto  doceri  non  posse.  Quam  responsionem,  cum  S.  S. 
D.  N.  in  audientia  ejusdem  Feriae  et  diei  plene  confirm- 
averit,  Eminentiae  tuae  communico,  tuasque  manus  hu- 
millime  deosculor,  humillimus  ac  addictissimus  servus 
verus. 

Romae,  21  Maii  1884. 

R.  CARDINALIS  MONACO. 


252  PASTORAL    MEDICINE. 

IV.    THE  PORRO  SECTION. 

In  recent  times,  some  operations  are  much  spoken  of 
which  we  can  not  pass  over  with  silence,  to  wit,  the  cas- 
tration of  the  woman  and  the  so-called  Porro  section. 
The  castration  of  the  woman  consists  in  the  extirpation 
of  her  ovary,  for  one  reason  or  another.  It  is  not  known 
to  me  that  the  castration  has  ever  been  advised  for  the 
purpose  of  sterilization.  Castration  is  indicated  partly  in 
the  case  of  big  sores  or  ulcers,  in  the  ovary  or  a  degenera- 
tion of  the  latter,  partly  in  the  case  of  certain  nervous 
diseases,  believed  to  originate  in  the  ovary,  which  are  of 
so  lasting  and  violent  a  nature  as  to  make  life  a  burden  to 
the  patient ;  hence  the  opinion  that  the  castration  is  justi- 
fied. The  question  about  the  origin  of  these  nervous  dis- 
eases being  by  no  means  settled,  many  an  error  and  a  fail- 
ure may  go  along.  However,  there  will  be  hardly  any 
objection  from  a  moral  point  of  view,  after  it  once  has 
been  more  clearly  defined  by  experience  where  and  when 
that  operation  be  indicated,  provided  it  is  not  made  for 
the  sake  of  sterilization,  or  needlessly,  or  frivolously. 

In  respect  to  Porro's  operation  matters  lie  somewhat 
different.  Prompted  by  the  poor  results  as  obtained  in 
Italy  and  France  from  cesarean  section,  which  in  his 
opinion  were  due  to  the  frequently  enormous  and  irrepres- 
sible hemorrhages;  and  on  the  other  hand,  encouraged 
by  the  success  attained  in  extirpating  uterus  and  ovary 
of  non-pregnant  women,  Professor  Porro,  of  Pavia,  in 
1876,  gave  to  cesarean  section  a  different  form. 

In  one  case  of  unquenchable  hemorrhage,  after  cesarean 
section,  he  successfully  extirpated  uterus  and  ovary  after 
extracting  the  child.  At  once  other  surgeons  in  France, 
Germany  and  Austria  followed  suit,  achieving  more  or 


DANGEROUS  OPERATIONS.  253 

less  good  results.  This  operation  soon  was  performed 
for  some  cause  other  than  perilous  hemorrhage;  for  in- 
stance, because  of  degeneration  of  the  tissues  of  the 
womb,  or  of  the  ovary,  or  because  of  ulcers  on  these  parts. 
Later  on,  this  operation  was  extended  to  cases  where  there 
was  only  a  narrowness  of  the  pelvis,  without  any  degener- 
ation of  the  groin  or  dangerous  hemorrhages,  the  purpose 
of  the  operation  being  to  render  a  future  conception  by 
the  patient  impossible,  so  that  she  never  again  would  have 
to  undergo  cesarean  section.  This,  to  my  mind,  trans- 
gresses the  limit  of  what  is  allowed.  If  the  pelvis  is 
so  absolutely  narrow  that  the  woman,  in  case  of  her  preg- 
nancy, could  only  be  delivered  by  means  of  the  cesarean 
section,  then  the  danger  to  her  life  is  very  remote  indeed. 
To  begin  with,  it  is  not  at  all  certain  whether  she  will 
ever  become  pregnant  again;  furthermore,  delivery  by 
means  of  the  section  includes  but  a  relative  danger  of 
life,  as  we  have  shown.  Now,  it  is  proposed  to  stave  off 
this  remote  danger  by  an  operation  almost  fully  as  dan- 
gerous as  the  old  cesarean  section,  making  impossible 
thereby  her  fecundity,  destroying  the  purpose  of  mar- 
riage, and  committing  an  annihilating  assault  upon  the 
natural  destiny  of  woman.  Tempting  as  the  thought  may 
be  to  spare  the  woman  a  future  danger  from  cesarean  sec- 
tion by  Porro's  operation,  this  process  can  never  be  coun- 
tenanced either  if  judged  by  natural  law  or  by  Christian 
morality. 

V.    SURGICAL  OPERATIONS  WITH  DANGER 
TO  LIFE. 

They  are  performed  to  avert  a  probable  or  immediate 
peril,  sometimes  also  for  removing  very  troublesome  or 
disfiguring  growths.  Grave  operations  performed  with 
a  view  to  placing  the  patient  beyond  danger  of  death  are 


254  PASTORAL    MEDICINE. 

permitted,  because  they  hold  out  promise  of  a  probable, 
or  at  least  possible,  rescue,  in  place  of  an  anticipated 
death.  These  operations  are  likewise  permitted  if  the 
peril  to  be  warded  off  is  only  probable  and  more  re- 
mote, provided  that,  if  the  operation  be  deferred  too 
long,  the  illness,  and  with  it  the  peril,  are  apt  to  increase, 
while,  at  the  same  time,  the  vitality  of  the  patient  is  de- 
creasing; hence  the  chances  for  a  successful  operation 
are  continually  lessened. 

It  would  be  different,  however,  if  the  dangerous  opera- 
tion were  to  be  performed,  not  because  the  patient's  life  is 
in  danger,  but  for  the  removal  of  some  disfiguring  or 
troublesome  ailment.  In  this  case  the  sanction  could  not 
be  granted  unqualifiedly.  It  would  be,  in  the  first  place, 
for  the  surgeon  to  decide  whether  the  operation  under  the 
prevailing  conditions  is  permissible  or  not.  If  the  ailing  is 
too  troublesome  or  disfiguring,  then  the  question  may  be 
answered  affirmatively. 

An  analogous  example,  much  mooted  by  moralists,  may 
here  be  quoted.  Supposing  some  one  unjustly  held  in 
captivity  and  suffering  all  kinds  of  hardships  had  no 
way  to  escape  except  by  risking  his  life.  The  attempt, 
if  successful,  would  mean  liberty  and  happiness  for  him ;  a 
failure,  loss  of  life.  Preferring  death  to  an  intolerable 
captivity,  would  it  be  right  for  him  to  risk  his  life  for 
liberty?  This  should  be  admitted,  provided  he  has  rea- 
sonable chances  for  succeeding.  A  dangerous  operation 
may  present  a  similar  case.  In  a  different  situation,  how- 
ever, when  the  operation  cannot  be  sanctioned,  the 
patient  has,  of  course,  no  right  to  request  it,  and  the 
physician  must  refuse  to  grant  such  a  request. 

The  decision  whether  the  operation  is  permissible  must 
depend,  in  each  individual  case,  on  the  nature  of  the 
patient,  on  the  seriousness  of  his  trouble  and  on  the 


DANGEROUS  OPERATIONS.  255 

chances  for  a  successful  performance  of  the  operation. 
Happily,  however,  kindred  cases  are  quite  rare. 

Another  question  may  be  raised,  namely :  is  the  patient 
bound  to  submit  to  a  grave  operation,  either  because  his 
life  is  surely  endangered  or  because  of  a  very  disfiguring 
and  offensive  ailing?    This,  of  course,  is  to  be  denied. 
According  to  reliable  authorities  no  one  is  bound  to  un- 
dergo a  grave  operation  in  order  to  remove  a  certain 
danger  to  his  life,  even  if  the  chances  are  in  favor  of  its 
successful  performance.     "Non  teneris  vitae  servandae 
causa  pati  amputationem  cruris  sive  brachii,  aut  incisionem 
z'entris  ad  extrahendum  calculum."   (Liguori.)   But  to  my 
mind  it  should  not  be  overlooked  that  the  above  decision 
perhaps  needs  to  be  modified,  in  view  of  the  vast  progress 
made  by  both  medicine  and  surgery,  inasmuch  as  grave 
operations  are  performed  nowadays  under  altogether  dif- 
ferent circumstances,  and  mostly  with  better  success,  than 
formerly.   "Non  tenetur  quis,"  says  Gury,  "servare  vitam 
remediis  extraord'mariis,  quaeque  MAXIMUM  DOLOREM  af- 
ferant;  non  datur  enim  obligatio  servandae  vitae,  nisi  me- 
diis  ordinariis,  quae  magna  non  adducunt  incommoda,  .  . 
neque  dolores  valde  acerbos  causant"  Says  Scavini,  in  his 
"Theologia  Moralis  Universa":  "Cum  servare  vitam  op- 
erations DOLORES   NIMIS  ATROCES  afferente  extra  com- 
munes vires  positum  sit."    Thus,  the  main  stress  is  laid 
upon  the  pains  and  hardship  which  the  operation  entails. 
But  what  is  to  be  said  now,  when  most  of  the  grave  op- 
erations are  almost  painless,  owing  to  the  use  of  chloro- 
form and  other  narcotics  ?    Is  the  mere  determination  to 
submit  to  a  likely  successful  and  in  itself  painless  opera- 
tion in  order  to  escape  an  otherwise  certain  death  likely 
to  call  for  any  great  effort  on  part  of  the  patient?  The  fact 
of  the  operation  being  rendered  painless  by  the  use  of  nar- 
cotics is  well-known  to  the  layman,  hence  his  fear  and  ter- 


256  PASTORAL    MEDICINE. 

ror  of  the  surgical  knife  have  been  greatly  diminished. 
This  must  influence  our  decision  to  some  extent.  Granted 
the  incision  may  later  on  cause  pain  to  the  patient,  this 
pain  generally  will  not  be  any  more,  mostly  much  less,  se- 
vere, than  the  pain  caused  by  the  ailment  which  necessi- 
tates the  operation,  which  pain  the  patient  has  to  en- 
dure, and  which  he  would  still  have  to  endure,  if  not 
operated  upon.  Aside  of  the  pain,  there  is  to  consider, 
perhaps,  some  permanent  disfigurement  as  a  result  of  the 
life-saving  operation,  for  instance  the  loss  of  a  limb.  But 
even  this  hardship  is  nowadays  mitigated  or  remedied  by 
the  improved  manufacture  of  artificial  limbs,  etc.,  which 
has  reached  a  perfection  not  dreamed  of  in  former  times. 
Not  only  is  the  disfigurement  done  away  with,  but  even 
the  usefulness  of  the  lost  parts  is  more  or  less  restored. 

All  these  instances  ought  to  modify  the  decision  of  the 
question  as  it  seems.  However,  the  thesis  propounded  by 
the  moralists  ought  well-nigh  to  remain  unchallenged  as 
often  as  a  patient  feels  overawed  by  the  thought  of  the 
operation,  the  progress  in  modern  surgery  notwithstand- 
ing. Natures  vary  in  their  sensitiveness. 

CESAREAN  SECTION/ 

Special  mention  must  be  made  at  this  juncture  of  an  op- 
eration important  in  various  ways,  to  wit,  the  cesarean  sec- 
tion. According  to  the  laws  of  science  and  morality  the 
cesarean  section  is  indicated  after  a  situation  has  arisen 
where  delivery  in  the  usual  way  can  only  be  rendered  pos- 
sible by  an  occision  of  the  child,  or  worse,  where  even  the 
Decision  of  the  child  would  not  avail  to  make  possible  an 
extraction  along  the  natural  passageway.  In  the  first  case, 
if  the  section  is  not  resorted  to,  the  child  could  not  be 
extracted  until  after  its  death,  and  only  by  dint  of  .1. 

1  See  also  page  247. 


CESAREAN  SECTION.  257 

painful  and  always  dangerous  operation  upon  the  mother. 
In  the  second  case,  both  mother  and  child  would  be  sure 
to  perish  in  default  of  cesarean  section.  In  considering 
whether  or  not  to  submit  to  cesarean  section,  the  mother 
has  not  only  to  consider  her  own  welfare,  but  also  the 
welfare  of  the  child,  which  is  bound  to  die  unless  the  sec- 
tion be  performed.  That  the  child  must  not  be  killed  for 
the  sake  of  its  mother  has  been  stated  above;  here  the 
question  will  arise,  "Is  it  permissible  for  the  mother  to 
let  her  child  die  when  it  could  probably  be  saved  by 
cesarean  section?" 

In  the  case  of  the  extraction  of  the  perforated  dead 
body  of  the  child  along  the  natural  passageway  the 
mother,  having  refused  to  undergo  the  cesarean  sec- 
tion, will  have  to  face  the  hardly  smaller  danger 
incidental  to  perforation.  We  have  shown  previously 
that  the  latter  operation  is  quite  as  dangerous  as  the  sec- 
tion, chiefly  because,  in  waiting  for  the  child  to  die,  the 
vitality  of  the  mother  becomes  more  and  more  sapped, 
until  finally  the  operation  is  performed  under  adverse 
circumstances.  The  moralists  lay  stress  upon  the  hor- 
ror of  the  operation,  but  its  damaging  effect  may,  if 
necessary,  be  diminished  to  a  great  extent,  or  even  nulli- 
fied by  the  use  of  chloroform  or  other  anaesthetics.  The 
"peritia  medici"  demanded  by  the  moralists,  is  just  as  nec- 
essary in  performing  occision  as  in  performing  the  sec- 
tion, hence  does  not  affect  the  choice  between  the  two  op- 
erations. To  sum  up,  if  mother  and  child  are  physically 
strong  enough,  so  that  hopes  for  preserving  both  lives 
may  be  entertained  in  reason,  then  the  mother  should  be 
urged  to  submit  to  the  section. 

The  aforesaid  applies,  with  greater  force  still,  to  the 
second  case,  where  even  perforation  would  not  answer 
the  purpose  of  rendering  extraction  along-  the  natural 


258  PASTORAL    MEDICINE. 

passageway  possible,  to  the  therefore  so-called  absolute 
indication  for  the  section.  In  this  case  both  mother  and 
child  are  confronted  by  certain  death,  and  the  mother 
should  be  urged,  even  for  the  sake  of  her  own  life,  but, 
moreover,  in  view  of  a  possible  saving  of  both  lives,  to 
undergo  the  cesarean  section.  It  is  true,  as  the  moralists 
say,  this  is  a  medium  extraor  dinar  ium  ad  servandum  vitam, 
therefore  the  mother  who  stands  in  too  great  a  dread  of 
the  operation  should  not  be  bidden  under  penalty  of  com- 
mitting a  grave  sin  to  make  the  sacrifice  for  the  sake 
of  preserving  her  own  temporal  life  or  that  of  her  child. 
In  one,  and  only  one,  instance  it  is  for  theology  to 
decide  whether  the  mother  is  obliged  to  submit  to  the 
dreaded  operation  for  the  sake  of  the  eternal  salvation  of 
her  child,  namely,  if  the  child,  bound  to  perish  otherwise, 
could  be  saved  with  reasonable  certainty  by  the  cesarean 
section  and  if  the  christening  of  the  child  with  the  aid  of 
instruments  would  be  either  impossible  or  too  uncertain. 
From  a  medical  point  of  view  it  may  be  mentioned  that 
a  number  of  sections  are  still  being  made  without  the 
aid  of  anaesthetics  and  I  repeatedly  have  had  occasion  to 
convince  myself  of  the  fact  that  women  can  stand  the 
operation  without  anaesthetics  in  spite  of  its  painfulness. 
The  feeling  of  horror  before  the  operation  is  sometimes 
worse  than  the  operation  itself,  because  nothing  is  more 
dreaded  by  the  laymen  than  the  incisio  ventris.  I  am  con- 
vinced the  operations  necessary  for  the  occision  and  sub- 
sequent extraction  of  the  child  are  causing  more  pain  than 
the  section,  yet  they  seem  not  so  dreadful  to  the  laymen, 
because  they  allow  of  the  extraction  along  the  natural 
passageway,  and  because  all  the  cutting  and  lancing  is 
made  upon  the  child's  body,  not  upon  the  mother. 


OTHER  OBSTETRIC  OPERATIONS.       259 

VI.  OTHER  OBSTETRIC  OPERATIONS. 

As  to  the  question  whether  the  rest  of  obstetric  opera- 
tions be  allowed,  or  obligatory,  there  is  clearly  no  room 
left  for  doubt,  provided  they  are  properly  and  truly  war- 
ranted. The  use  of  the  forceps,  the  operation  of  turning 
around,  or  the  bringing  about  of  the  premature  birth,  if 
done  according  to  the  dictates  of  science,  to  wit,  in  due 
time  and  properly  executed,  serve  the  purpose  of  deliver- 
ing the  mother  for  the  sake  of  her  welfare  and  that  of  her 
child. 

Premature  birth,  i.  e.,  bringing  on  delivery  before 
pregnancy  has  run  its  full  course,  yet  at  a  time  when 
the  child  is  quite  sufficiently  developed  for  a  separate  ex- 
istence away  from  its  mother,  is  likely  to  jeopardize 
the  child's  life,  inasmuch  as  its  organs  are  not  quite  per- 
fectly developed,  hence  not  equal  to  the  influences  of  the 
surroundings  and  the  changed  mode  of  its  nutrition.  This 
operation  enters  into  consideration  in  cases  where  the  de- 
livery, at  the  natural  end  of  pregnancy,  can  positively  be 
only  effected  by  a  grave  operation,  perilous  for  both 
mother  and  .child,  or  only  (aside  of  cesarean  section)  by 
perforation  of  the  child,  while  at  the  same  time  it  would 
be  reasonable  to  assume  that  by  premature  birth  the 
child  would  be  born  alive  and  remain  alive,  while  the 
mother  had  not  been  put  to  any  considerable  danger.  In 
this  case  it  should  not  be  made  obligatory  for  the  mother 
to  await  the  natural  term  of  her  pregnancy,  and  thus  place 
herself  in  danger  of  death.  Hence  the  artificial  inducing 
of  premature  birth  is  allowed,  and  the  mother  may  even 
have  the  obligation  to  choose,  for  her  own  sake,  such  a 
reasonable  escape  from  a  fatal  situation,  especially  as  she 
can  plead  against  it  neither  great  pains  nor  an  uncon- 
querable horror. 


260  PASTORAL    MEDICINE. 

The  above  applies,  to  an  even  higher  degree,  perhaps, 
to  the  second  order  of  indications  for  premature  birth: 
perilous  diseases  of  and  accidents  to  the  woman  in  preg- 
nancy, at  a  time  when  there  is  a  probability  for  saving  her 
life,  by  bringing  on  an  early  birth.  Had  the  mother  died 
before  her  delivery,  then  the  child  would  be  in  utmost 
peril ;  hence  early  birth,  also  in  this  case,  is  beneficial  to 
mother  and  child. 

Finally,  we  must  mention  the  sectio  caesarea  post  mor- 
tem matris.  Should  her  death  occur  after  completing  the 
twenty-eighth  week  of  her  pregnancy,  then  the  sectio 
caesarea  is  absolutely  demanded  without  regard  to  the  life 
of  the  child.  In  view  of  the  possible  baptism  of  the  child, 
it  is  questionable  whether  this  limit  to  twenty-eight  weeks 
is  proper.  I  am  inclined  to  doubt  it.  True,  there  may  be 
small  chance  of  extracting  the  fetus  alive  by  means  of  the 
section,  if  the  death  has  been  in  the  first  months  of  preg- 
nancy ;  not  so,  however,  after  the  completion  of  the  fourth 
month.  Therefore  I  would,  in  order  to  christen  the  child, 
perform  the  section  unless  it  was  proved,  by  weighty 
reason,  that  the  child  had  died  before  or  together  with  its 
mother.  I  would  especially  perform  the  sectio  caesarea 
upon  all  pregnants  that  have  died  suddenly  or  after  very 
short  sickness. 

The  section  must,  of  course,  be  performed  as  soon  as 
possible  after  death.  At  times  this  may  be  a  difficult 
matter;  there  are  some  cases  of  sudden  deaths  where 
it  is  not  at  all  easy  to  make  sure  whether  death  has  actu- 
ally set  in  or  not.  This,  however,  is  the  physician's  busi- 
ness, who  may  show,  in  such  contingencies,  what  skill 
and  decision  may  do.  He  will  use  the  same  care  in 
performing  upon  the  dead  as  on  the  living  woman,  and 
even  in  case  of  asphyxia  of  the  mother  no  serious  injury 
will  have  been  done. 


OTHER  OBSTETRIC  OPERATIONS.       261 

But  what  in  the  absence  of  the  physician?  What  in 
the  case  of  his  being  too  far  off  (as  is  often  the  case  in  the 
country),  or  if  he  can  not  be  had?  Should  it  behoove  the 
priest  to  perform  the  operation  ?  It  has  been  done  by  res- 
olute priests,  bent  on  soul-saving,  but  I  am  against  it.  I 
can  not  coincide  with  the  worthy  Vering,  who  holds  that 
the  priest  should  make  himself  acquainted  with  the  sec- 
tion, and  that  it  is  his  duty  to  perform  it,  if  necessary, 
rather  than  let  the  child  die  unbaptized.  That  the  op- 
eration is  unbecoming  to  the  priest  need  not  be  demon- 
strated. With  the  same  right,  he  may  be  asked  to  study 
the  whole  of  obstetrics  and  to  play  midwife  in  case  of 
emergency.  It  would  be  no  more  unbecoming  for  the 
priest  to  save  mother  and  child,  in  case  of  both  being 
endangered  by  placenta  praevia,  by  promptly  delivering 
the  mother,  than  to  save,  perhaps,  the  child  by  per- 
forming the  sectlo  caesarea.  The  only  difference  be- 
tween the  two  is  that  in  the  former  case  everybody  would 
declare  it  absurd  to  demand  such  service  from  the  priest, 
while  in  the  second  case  some  one  has  said  it  should 
be  that  way,  because  it  has  been  done,  therefore  ap- 
pears to  be  feasible.  This  fallacy  is  comprehensible, 
because  the  performance  of  the  section,  to  the  mind 
of  the  non-physician,  is  a  heroic  deed,  and  we  are  apt  to 
overlook  and  forgive  the  unbecoming  on  account  of  the 
heroic.  The  undertaking  of  the  sectio  caesarea  by  the 
layman,  however,  is  not  only  unbecoming,  but  risky. 
Aside  from  the  difficulty  to  ascertain  whether  the  mother 
is  really  dead,  the  performance  of  the  operation  re- 
quires not  only  a  thorough  knowledge  of  the  respective 
parts,  but  also  a  considerable  surgical  skill  which  the 
layman  would  lack,  even  if  he  should  know  by  heart 
the  most  accurate  description  of  the  operation.  The 
cesarean  section  on  the  body,  warm  and  fresh,  of  a 


262  PASTORAL    MEDICINE. 

woman  just  deceased,  is  even  for  experts  a  very  exacting 
operation,  especially  because  it  mostly  must  be  performed 
without  expert  assistance,  the  time  being  too  precious  to 
lose  it  in  trying  to  obtain  such  assistance.  The  alarming 
case  in  itself,  the  excitement  and  suspense — whether  or  not 
the  corpse  will  stir  at  the  first  incision — the  constant  gush 
of  warm  blood — all  these  are  things  which  would  af- 
fect any  one  but  an  expert,  who  remains  calm  because 
familiar  with  the  operation  and  used  to  bloody  surgery. 
Who,  then,  can  reasonably  demand  that  it  be  made  man- 
datory of  the  priest  to  perform  the  section  in  case  of 
emergency,  when  he  has  but  a  vague  idea  of  the  operation, 
gleaned  from  an  aphoristic  description  of  the  same  ?  The 
little  he  knows  of  the  operation,  would  it  not  become  en- 
tirely useless  in  his  natural  trembling  and  hesitancy,  and 
would  not  the  success  of  the  operation  be  thereby  rendered 
improbable  to  the  highest  degree?  I  shall  not  allude  to 
other  evils  in  the  wake  of  such  a  process.  Who  will  pro- 
tect him  from  slander,  given  rise  to  by  the  circumstances 
of  a  proceeding  uncommon  for  a  layman?  Will  not  the 
people  ask,  "Why  did  he  meddle?  It  was  not  his  busi- 
ness." 

Whether  or  not  it  may  be  permissible  for  the  priest  to 
perform  the  incisio  in  case  of  emergency,  that  is  for  the 
ecclesiastical  authority  to  decide.  A  decree  of  the  Holy 
Office  for  missionaries  prohibits  them  to  venture  such  a 
performance,  and  advises  them  to  confine  themselves  to  in- 
structing others  in  their  duties  and  to  keep  them  duti- 
ful. ("Ne  missionarii  in  casibus  particularibus  se  in- 
gerant  in  demandanda  sectione,  multo  que  minus  in  ea 
peragenda.") 

Of  late  Dr.  Max  Bunge  advises  the  cesarean  section 
upon  the  dying  woman,  an  operation  which  heretofore  has 


OTHER  OBSTETRIC  OPERATIONS.       263 

only  been  scatteringly  performed.  He  says:  "If  diag- 
nosis and  prognosis  by  the  physician  should  foretell  him 
the  certain  death  of  a  highly  pregnant  woman  in  short 
order ;  if  the  fetus  can  be  proved  to  be  living ;  if  the  de- 
livery by  way  of  the  pelvis  channel  should  fail  to  offer  a 
better  prognosis;  finally,  if,  in  view  of  the  impending 
exitus  letalis,  no  success  can  be  expected  from  bringing 
about  delivery,  then  the  cesarean  section  should  be  per- 
formed without  delay,  as  soon  as  the  woman  shows  cer- 
tain symptoms  which,  we  know,  indicate  that  the  child, 
in  the  shortest  of  time,  will  precede  its  mother  in  death 
(asphyxia  of  the  mother,  decrease  in  the  pressure  of  the 
blood  combined  with  long  agony,  excessively  high  tem- 
perature, etc.).  It  may  sometimes  be  possible  to  observe 
this  impending  danger  in  the  palpitation  of  the  infant's 
heart. 

That  such  a  course  be  allowable,  by  consent  of 
the  dying,  or,  if  she  be  unconscious,  by  her  folks,  is  never- 
theless doubtful.  It  can  not  be  denied  that  it  revolts  the 
sentiment  to  the  utmost.  Although  Bunge  places  little 
value  upon  this  objection,  it  will,  as  a  rule,  be  the  reason 
why  relatives  will  refuse  their  consent.  Besides,  it  will 
be  quite  difficult  to  select  the  right  moment  for  the  opera- 
tion. One  may  defer  it  too  long  or  else  begin  it  too 
soon.  Possibly  the  dying  mother  is  operated  upon,  only 
that  a  dead  child  be  extracted  (even  if  the  child  was 
seemingly  alive  a  moment  ago)  ;  another  time  a  seemingly 
dying  mother  is  operated  upon,  yet  she  does  not  die  of  her 
disease.  In  that  case  her  danger  from  her  existing  mal- 
ady would  only  have  been  increased  unnecessarily  by 
the  cesarean  section.  Because  of  these  difficulties  this 
operation  is  not  likely  to  be  performed,  except  in  rare 
instances. 


264  PASTORAL    MEDICINE. 

VII.    ECTOPIC  GESTATION.  CLEAR  OVA. 

Ectopic  conception  and  gestation  take  place  when,  by 
an  accident,  the  nascent  human  form  is  lodged  extra- 
uterine,  in  some  recess  not  intended  nor  suited  to  pro- 
tect its  early  growth. 

The  possibility  of  saving  the  fetus,  i.  e.,  the  child,  with- 
out destroying  the  life  of  the  mother,  seems  to  exist  in 
many  cases  of  ectopic  gestation. 

Ectopic  conceptions  are  not  as  rare  as  might  be  sup- 
posed, one  doctor  having  reported  fifty  cases  as  having 
occurred  within  his  own  practice,  another  eighty-five. 

The  fact  that  a  diagnosis  of  ectopic  conception  and 
gestation  is  often  extremely  difficult,  sometimes  even  im- 
possible, is  of  considerable  importance  in  the  matter.  "A 
mere  possibility  can  not  be  the  basis  of  a  strict  moral  ob- 
ligation ;  hence  a  physician  who  has  tried  in  vain  to  ascer- 
tain whether  an  ectopic  growth  does  or  does  not  contain 
a  living  fetus  must  consult  the  interest  of  the  mother, 
without  being  deterred  by  the  possibility  of  an  abnormal 
conception.  The  physician  has  then  the  right  to  assume 
that  it  is  not  a  child,  because  monstrosities  are  not  to  be 
supposed."1 

If,  however,  it  is  ascertained  that  the  growth  is 
really  a  living  fetus,  the  case  falls  under  the  decree  of 
the  Sacred  Congregation  of  May  4,  1898: 

"Necessitate  cogente,  licitam  esse  laparotomiam  ad  ex- 
trahendos  e  sinu  matris  ectopicos  conceptus,  dummodo 
et  foetus  et  matris  vitae,  quantum  fieri  potest,  serio  et  op- 
portune provideatur." 

In  English :  In  a  case  of  extra-uterine  pregnancy  doc- 
tors may,  when  compelled  by  necessity,  perform  lapa- 
rotomy  to  extract  the  extra-uterine  fetus,  provided  proper 

1  Rev.  R.  Holaind,  S.J.,  in  Am.  Eccles.  Review. 


ECTOPIC  GESTATION— CLEAR  OVA.     265 

and  conscientious  care  be  taken  of  the  lives  of  both  mother 
and  child,  as  much  as  possible. 

It  is  an  open  question  just  how  quantum  fieri  potest  in 
the  decree  is  to  be  construed.  That  the  operation  is  law- 
ful when  the  fetus  has  become  viable  was  evident  before 
this  decision  and  we  trust  the  exact  range  of  the  decision 
will  be  made  clear,  beyond  all  doubt,  by  the  Sacred  Office. 
It  can  not  be  doubted,  however,  that  the  immortal  soul 
of  the  fetus  is  to  be  safeguarded,  no  matter  whether  the 
fetus  is  in  its  proper  place  or  not. 

CLEAR  OVA  are  formed  simply  of  accessories  and 
contain  no  trace  of  life  or  of  a  fetus.  In  these  cases  the 
embryo  dies  spontaneously  during  the  first  weeks  of  preg- 
nancy, before  the  appearance  of  the  bones.  The  dead 
fetus  then  gradually  dissolves,  but  the  strange  part  of  this 
anomaly  is,  that  the  annexes,  membranes  and  placenta 
continue  to  develop  for  a  period  more  or  less  long,  bring- 
ing on  uncontrollable  vomiting  and  endangering  the  life 
of  the  mother  unless  the  growth  is  removed  by  operation. 
To  the  medical  science  of  to-day  no  means  is  known  to 
positively  determine  whether  the  ovum  in  the  uterus  is  a 
clear  or  a  living  ovum. 

The  living  fetus  is  of  course  under  all  conditions  en- 
titled to  the  protection  which  the  Holy  Office  has  pre- 
scribed for  it.  However,  if  the  physician,  in  a  grave  case, 
believes  he  has  good  reason  to  assume  that  there  is  a  clear 
ovum  and  no  life  present,  he  has  probably  the  right  to 
consult  solely  the  interest  of  the  mother,  as,  in  the  words 
used  by  Rev.  Holaind,  S.J.  anent  extra-uterine  gestation, 
quoted  above,  "a  mere  possibility  can  not  be  the  basis  of  a 
strict  moral  obligation."  Under  all  circumstances  the 
operator  must  be  prepared  to  administer  baptism  the  very 
moment  he  detects  or  suspects  life  in  the  fetus  or  ovum, 
even  though  he  has  not  expected  to  find  it 


NEURASTHENIA 
In  Its  Pastoral- Psychiatric  Aspects. 

INTRODUCTION. 

WITHIN  the  last  few  decades  the  nervous  diseases,  in 
their  thousandfold  shapes,  have  increased  to  an 
alarming  extent.  The  exact Joiowledge  of  these  forms  of 
morbidity,  however,  has  not  kept  pace  with  their  growth. 
Only  twenty  years  ago  decided  neurasthenics  were  diag- 
nosed as  hypochondriacs,  and  neurasthenia  was  looked 
upon  as  nothing  else  but  some  modification  of  either 
hypochondria,  or  hysteria,  or  melancholy.  The  essence  of 
these  morbid  apparitions  being  misjudged,  their  rational 
treatment  was  in  consequence  prevented.  In  more  recent 
times,  some  gratifying  disclosures  anent  the  various  ner- 
vous diseases  have  been  obtained  as  a  result  of  psychiatric 
research.  That  a  knowledge  of  morbid  conditions  grow- 
ing out  of  neurasthenia  is  not  only  highly  valuable  to 
the  physician,  but  also  to  the  educator,  teacher,  lawyer, 
and  not  in  the  least  degree  to  the  priest,  goes  without 
saying.  The  learned  Benedictine,  Rev.  Anselm  Ricker, 
verily  says,  in  his  "Pastoral  Psychiatry:"  "A  priest, 
who  has  gained  psychiatric  knowledge  will  be  kind 
and  prudent  in  dealing  with  the  mentally  afflicted,  and  will 
save  many  a  man  from  great  misfortune."  Hence  it 
will  not  be  amiss  to  deal  with  those  of  the,  only  too 
many,  apparitions  of  mental  morbidity  which  are  of  par- 
ticular interest  for  the  priest,  because  of  their  many  far- 
reaching  effects  upon  religious  life  and  sentiment.  For 
it  is  the  priest  who  may  be  in  a  position  to  learn  of  the 
most  secret  trend  of  thoughts,  and  who  not  seldom  is 

266 


NEURASTHENIA.  267 

made  the  confidant  by  persons  suffering  from  being  "not 
understood  by  a  cold  world,"  and  who  turn  to  him,  in  the 
hope  that  he  may  understand  their  mental  condition  and 
suffering. 

Such  mental  suffering  is  to  be  found  in  compulsory 
thoughts,  compulsory  notions,  and  in  compulsory  condi- 
tions in  general.  Hansjakob,  a  German  author,  has  force- 
fully described  the  power  exercised  by  the  compulsory 
images  over  the  morbidly  irritable  soul.  We  may  believe 
what  he  tells  of  it  in  his  book  "Days  of  Sickness,"  for  he 
is  relating  his  own  personal  experience:  "Let  him  who 
never  has  been  afflicted  with  compulsory  notions  thank 
God  and  his  good  nerves  for  not  knowing  these  furies, 
against  whom  will  and  reason  are  equally  powerless.  Com- 
pulsory notions  are  for  soul  and  mind  what  lashes  are  for 
the  body,  only  lashes  are  as  balm  compared  with  those 
illusions,  because  mental  sufferings,  mental  tortures  are  in 
general  more  hurtful  and  tantalizing  than  physical  pains." 

Of  course,  he  who  never  has  had  occasion  to  observe 
this  ailment  in  its  entire  depth  and  broadness,  and  to 
watch  it  in  its  course,  will  be  readily  at  hand  with  a  judg- 
ment that  can  only  be  wrong,  or  with  advice  that  fails  to 
help.  At  best  the  uninitiated  will  counsel  the  afflicted  to 
try  to  banish  those  stupid,  silly,  ridiculous  thoughts.  The 
unfeeling  ignoramus  will  make  the  cutting  remark,  "That 
man  is  crazy  and  ought  to  be  in  an  asylum."  Another 
will  find  it  incomprehensible  why  those  thoughts,  together 
with  the  impulse  they  give  to  perverse  actions,  might  not 
be  overcome  by  exerting  the  will-power.  The  well-mean- 
ing, spiritual  adviser,  who,  though  well-meaning,  is  unac- 
quainted with  this  condition,  will  say,  perhaps,  "These  are 
nothing  but  temptations  and  distractions,  which  ought  to 
be  despised." 


268  PASTORAL    MEDICINE. 

The  latter  view  is  the  more  readily  formed,  because 
these  compulsory  notions  often  present  themselves  in  the 
false  garb  of  temptations,  and  prove  the  more  irri- 
tating, confusing  and  alarming  the  more  they  concern 
themselves  with  vital  questions  of  religious  life  and  the 
more  they  harass  moral  notions. 

The  above  considerations  make  it  clear  how  valuable 
a  thorough  knowledge  of  these  mental  states  and  pro- 
cesses, with  their  so  unstable  border  lines,  will  be  for 
the  priest,  for  the  purpose  of  his  gaining  a  clear  insight 
in  a  given  case  and  of  his  exerting  a  favorable  influence 
upon  the  afflicted.  The  aphorism:  "To  understand  all 
means  to  forgive  all"  contains  a  great  deal  of  practical 
wisdom,  and  applying  it  to  our  subject,  we  may  well  say : 
He  who  has  gained  some  insight  into  the  true  nature  of 
these  mental  processes  will  arrive  at  a  true  understanding 
of  them,  and  eventually  will  not  class  them  any  longer 
with  mortal  guilt. 

In  order  that  the  subsequent  discourse  may  be  better 
understood,  some  suitable  cases  may  first  be  enumerated. 
They  are  taken  from  the  book  entitled,  "La  folie  du 
doute,"  of  the  French  author  on  psychiatry,  Legrand  du 
Saulle. 

I.     CLINICAL  CASES  FOR  ELUCIDATION. 

I.  Case. — A  woman  patient  never  could  think  of,  talk  of,  or  do 
anything  at  all  without  employing  in  her  mind  at  the  same  time 
the  words  "  cursed,"  "  damned,"  or  "  calf."  She  could  not  get 
rid  of  the  impression  that  everything  she  did  would  be  cursed, 
would  be  damned,  no  matter  how  she  struggled  against  it,  no 
matter  how  much  she  was  even  aware  of  the  abnormal  in  this 
mental  process.  This  state  lasted  two  and  a  half  years,  where- 
upon she  regained  her  mental  balance  quite  suddenly.  For  the 
next  six  years  she  was  mentally  and  physically  in  good  health, 


COMPULSORY  NOTIONS  DEFINED.       269 

when  she  suddenly,  while  reading  a  newspaper,  took  the  notion 
that  her  husband  would  be  eternally  lost  She  could  not  get 
rid  of  that  notion  for  the  next  six  months. 

2.  Case. — A  woman,  very   intelligent  and   educated,   twenty- 
seven  years  of  age,  mother  of  two  children,  married  for  seven 
years,  and  always  most  fortunately  situated.    Upon  the  death  of 
one  of  her  friends  it  occurred  to  her  that  she,  too,  might  die  sud- 
denly.    By  and  by  her  mind  was  filled  with  other  delusions;  for 
example,  that  she  might  not  know  how  to  converse  in  society,  that 
people  by  looking  at  her  might  perceive  her  perverse  thoughts, 
etc.    The  upshot  was,  she  never  wanted  to  go  into  society,  to  the 
theater,  to  church,  being  kept  in  anxiety  and  perturbation  because 
of  her  delusions. 

3.  Case. — Reported   by   Esquirol.1     A  girl   of   eighteen  years 
was  in  constant  morbid  fear  of  having  wronged  somebody,  and 
never   could   overcome   this   thought.     Being  a  bookkeeper   she 
always  was  afraid  of  having  cheated  some  one  by  one  of  the 
bills  she  had  written  out  in  the  course  of  business.    Later  on  she 
had  to  look  time  and  again  over  the  bills  and  letters  to  be  sure 
she  had  made  no  mistake  or  error.    At  a  still  later  period  she 
was  afraid  to  handle  coins,  because  a  part  of  the  metal  might 
stick  to  her  fingers  and  the  coins  thus  be  robbed  of  a  part  of 
their  value.     She  said:  "I  know  my  notion  is  foolish  and  per- 
verse, but  I  can  not  overcome  it." 

II.     COMPULSORY  NOTIONS  DEFINED. 

Starting  from  the  above  cases,  which  characterize  both 
the  simple  compulsory  images  and  compulsory  conditions, 
our  first  question  is : 

What  Are  These  Compulsory  Images  Really? 

The  conception  is  as  old  as  humanity,  new  is  only  the 
name  which  was  coined  by  the  well-known  author  on 
psychiatry,  Krafft-Ebing,  who  began  first  to  describe  it  in 

1867. 

These   conditions   were   treated,   previous   1 
Ebing,  by  Fabret,  Sr.,  in  1866,  then  by  Morel,  Trelat  and 

'Traite  des  maladies  mentales,  page  331. 


270  PASTORAL    MEDICINE. 

others,  and  finally,  more  exhaustively,  by  Legrand  du 
Saulle  in  a  clever  monograph  entitled,  "La  folie  du  doute 
avec  delire  de  toucher."  The  various  terms  chosen  by  the 
French  for  these  morbid  psychical  apparitions,  such  as 
maladie  du  doute,  delire  partielle,  foli  avec  conscience, 
delire  emotif,  show  clearly  their  endeavor  to  separate 
these  conditions  from  the  mental  diseases  proper.  In 
Germany  a  description  of  compulsory  images  was  fur- 
nished chiefly  by  Dr.  Krafft-Ebing.  His  definition  fol- 
lows: "There  are  numerous  persons  with  a  mental 
or  nervous  ailing,  who  complain  of  not  being  able  to 
get  rid  of  certain  troubling  and  annoying  ideas,  although 
they  are  perfectly  aware  of  their  silliness  and  impro- 
priety ;  and  that  those  ideas  are  constantly  intruding  upon 
their  conscious,  logical,  associated  conception,  which 
cannot  be  brought  to  conclusion  because  of  the  distur- 
bance. As  a  result,  these  ideas  cause  the  patient  to  be- 
come irritated,  and  to  be  impelled  to  corresponding  ac- 
tions which  he  may  find  ridiculous  or  disgusting,  accord- 
ing to  their  nature."  Such  notions  fixed  enduringly  upon 
the  conscious  mind  with  morbid  intensity  are  called  "com- 
pulsory images."  Krafft-Ebing  emphasizes,  especially, 
"that  the  idea  arises,  in  a  state  of  mental  good  health, 
called  forth  perfectly  unsolicited  and  without  provoca- 
tion, and  that  it  keeps  itself  before*lhe  conscious  mind,  in 
spite  of  the  most  energetic  objection  by  the  will,  until  it 
vanishes  spontaneously.  It  should  be  well  noted  that 
these  notions  are  bearing  the  character  of  compulsory 
ideas  as  long  as  the  sound  judgment  struggles  against 
them  and  perceives  them  as  intruding  upon  the  normal 
flow  of  the  association  of  ideas." 

Moreover,  these  compulsory  notions  are  followed  by  a 
lack  of  desire  or  inclination ;  hence  they  differ  essentially 
from  another  only  superficially  similar  disturbance,  to 


COMPULSORY  NOTIONS  DEFINED.       271 

wit,  when  some  single  notion  sticks  to  the  mind.  The 
characteristics  of  that  disturbance  are  that  some  occurred 
notion,  no  matter  of  what  description,  reasserts  itself  time 
and  again  in  the  usual  course  of  thoughts.  Ordinarily  no 
notion  can  remain  for  a  long  period  on  the  surface  of  the 
flow  of  thoughts  unless  there  are  special  causes  to  incite 
that  notion  always  anew.  New  impressions  and  images 
which  are  constantly  jamming  themselves  into  the  con- 
scious mind  obtain  the  preponderance  as  soon  as  the  vivid- 
ness of  previous  pictures  begins  to  pale.  The  slower  the 
train  of  thought  progresses  the  easier  will  it  be  for 
single  notions  to  retain  their  supremacy.  Especially 
groups  of  ideas  of  a  rhythmic  arrangement,  a  verse,  a 
melody,  may  so  assert  themselves  sometimes,  that  we 
can  not  get  rid  of  them,  but  must  invariably  return  to 
them,  to  our  discomfiture,  till  they  finally  are  driven  in 
the  background  by  new  events.  Again,  in  our  speech  or 
writing  there  may  involuntarily  start  up  certain  expres- 
sions, or  figures  of  words,  which  we  find  impossible  to 
avoid,  try  as  we  may. 

In  contrast  to  the  compulsory  thinking,  we  many  times 
do  not  notice  such  continual  repetitions,  in  case  of  an 
idea  simply  adhering  to  the  mind,  until  afterwards;  it 
entirely  lacks  the  feeling  of  compulsion,  of  being  over- 
whelming despite  resistance,  no  matter  how  disagreeably 
we  may  be  affected  by  the  stubbornness  of  the  notions.  Dr. 
Koch  reports  of  two  cases.  One  of  a  girl  seven  years  old, 
whose  trains  of  thought  for  a  long  time  had  always  been 
intermingled  by  the  ideas  "eternity,"  "sempiternal," 
though  there  was  no  connection  between  them  and  the 
original  thought;  another  instance  that  of  a  woman, 
hounded  by  the  word  "Esslingen."  However,  these  cases 
should  not  be  classed  among  compulsory  ideas  because  in 
both  instances  there  is  extant  a  remembrance  of  the  word 


272  PASTORAL    MEDICINE. 

heard  or  read,  moreover  the  repetitions  enter  upon  con- 
sciousness only  afterward  and  the  feeling  of  compulsion 
is  lacking.  In  that  case  we  have  to  deal  with  an  almost 
unchanged  sediment  of  prior  actual  impressions,  whereas 
the  subject  of  a  compulsory  notion  is  accidental. 

Compulsory    Notions    Defined    According    to    Dr. 
Westphal  and  Dr.  Krafft-Ebing. 

Prior  to  Krafft-Ebing,  the  alienist  Dr.  Westphal  has 
applied  the  term  "compulsory  notions,"  in  the  sense  of 
the  former,  to  such  notions  "which,  leaving  the  intelli- 
gence otherwise  intact,  and  without  being  conditioned 
by  a  sentimental-like  or  affectionate-like  state,  enter  and 
occupy  the  foreground  of  consciousness,  against  and  con- 
trary to  the  will  of  the  respective  persons;  which  will 
not  be  banished ;  which  hinder  or  cross  the  normal  train 
of  thoughts ;  which  are  recognized  by  the  afflicted  as  being 
abnormal  and  foreign  to  his  mind,  and  which  he  opposes 
with  his  entire  consciousness."  To  Westphal  belongs  the 
credit  of  having  discerned  the  fact  that  these  compulsory 
notions  are  apt  to  appear  even  without  any  affective  base 
(without  primary  melancholy)  ;  also  that  they  represent 
a  mental  disease,  which  constitutes  a  class  by  itself,  owing 
to  their  continuance,  independence  and  certain  character- 
istics in  their  course  and  reactions. 

In  view  of  the  facts  of  their  existence,  it  is  easier  to 
state  what  compulsory  notions  are  than  to  state  whence 
they  come.  Krafft-Ebing  says :  "The  origin  of  the  com- 
pulsory notions  is  spontaneous.  Either  it  takes  the  con- 
sciousness by  sudden  surprise  or  it  has  been  called  forth 
by  an  external  event  of  shocking  influence  (murder,  ex- 
ecution of  capital  punishment,  conflagration,  suicide  of  one 
beloved,  etc.).  In  the  former  case  it  can  not  be  formed 


COMPULSORY  NOTIONS  DEFINED.       273 

in  the  usual  way  by  association  of  ideas,  but  must  be 
awakened  and  sustained  by  interior  physiological  stimula- 
tions upon  the  psychical  organ.  This  explains  why  its 
contents  are  foreign  to  the  mind  and  disturbing  the  con- 
scious image ;  this  explains  also  its  resistance  against  the 
associating  energy.  In  their  origin  they  are  like  prim- 
ordial deliriums,  in  contradistinction  to  notions  formed  by 
the  psychological  process  of  association  and  reflection. 
They  are  spontaneous  and  primary  creations  of  a  brain 
abnormally  organized  or  diseased,  immediate  mechanical 
productions  of  the  unconscious  mental  life,  the  same  as 
are  most  hallucinations  in  another  field  of  mental  mor- 
bidities." 

These  compulsory  notions  find  their  analogy  in  physio- 
logical life  in  images  which  interfere  with  and  distract 
calm  thinking,  in  notions,  melodious  airs,  which  do 
not  at  all  pertain  to  the  subject,  which  are  confound- 
ing, distracting  and  irritating,  and  which  can  only  be 
banished  by  dint  of  a  certain  exertion  of  the  will-power 
and  by  straining  the  mechanism  of  association.  Later  on 
we  shall  have  an  opportunity  of  pointing  out  many  a 
cause  for  the  origin  and  the  continuance  of  the  compul- 
sory notions,  but  for  the  sake  of  completeness  Krafft- 
Ebing's  explanation  of  what  causes  the  compulsory  ideas 
may  be  quoted  here.  Krafft-Ebing's  definition  contains 
all  the  marks  characteristic  of  a  compulsory  notion,  with- 
out making  a  distinction  between  notions  arising  spon- 
taneously, void  of  cognizable  association  and  enduring 
permanently  without  any  basis  of  affection,  and  those  that 
have  been  obtained  from  a  logically  proceeding  train 
of  thought,  and  have  been  retained  because  of  an  acci- 
dental coincidence  of  their  contents  with  the  mood  caused 
by  a  prevailing  element  of  affections.  However,  it  may- 
be assumed  that  both  groups  may  result  into  com- 


274  PASTORAL    MEDICINE. 

pulsory  notions,  whether  generated  without  any  asso- 
ciation at  all,  or  whether  taken  from  a  logical  train  of 
thought.  Krafft-Ebing's  remark,  of  the  person  laboring 
under  a  compulsory  notion  being  conscious  of  its  ab- 
surdity and  impropriety,  ought  not  to  be  interpreted  that 
every  compulsory  notion  is  in  itself  absurd,  for  his  con- 
sciousness of  the  senseless  and  silly  may  refer  just  as  well 
to  notions  the  contents  of  which  may  have  originated  with 
his  prior  images  as  with  notions  of  a  really  absurd  subject. 
For  example,  a  person  prompted  by  the  ever-returning 
thought  of  having  left  the  door  ajar,  goes  every  now  and 
then  to  close  the  door,  or  another  person  is  always  polish- 
ing some  metal  object  because  the  idea  "verdigris"  is  in 
his  mind.  These  may  be  just  as  silly  notions  as  if  one 
labors  under  the  idea  of  having  committed  perjury,  al- 
though he  never  has  been  in  court,  or  if  one  would  con- 
tinually ponder,  what  would  be  the  result  if  a  certain 
sensational  thing  would  happen  to  him. 

III.     COMPULSORY  NOTIONS  CAUSED  BY  A  DIS- 
TURBANCE IN  THE  SPHERE  OF  EMOTION. 

Under  what  conditions  can  these  disturbances  arise? 

Sentiments  are  not  decided  solely  by  the  course  of 
notions,  although  the  mutual  relation  of  the  notions  may 
be  able  to  generate  sentiments;  the  subject  of  a  single 
notion,  too,  may  be  very  pleasant,  or  painful.  The  senti- 
ment derives  its  color  from  the  object  of  the  compulsory 
notion  and  the  momentary  general  mood ;  the  accompany- 
ing anxiety  finds  its  explanation  in  the  frequent  ab- 
surdity of  the  notion.  Anent  the  relation  of  the  no- 
tions, it  is  known  that  an  undisturbed  train  of  thoughts 
creates  a  feeling  of  gratification  and  inclination ;  likewise 
it  is  a  matter  of  experience  that  obstacles  in  the  organism 


CAUSE  OF  COMPULSORY  NOTIONS.     275 

of  mental  life,  according  to  the  degree  of  intensity,  are  ac- 
companied by  a  feeling  of  uneasiness,  of  depression,  and 
finally  one  of  dread.  Should  the  subject,  of  the  com- 
pulsory notion  by  accident,  be  not  an  absurd  one,  then  the 
cause  of  the  annoyance  lies  in  the  stopping  of  the  train 
of  thoughts,  in  the  inability  to  bring  the  notion  to  a 
satisfactory  finish,  in  the  want  of  power  to  break  the  com- 
pulsion. Just  as  in  the  physical  domain  the  taking  of 
nourishment  awakens  different  feelings,  according  to  dif- 
ferent circumstances,  so  the  same  is  the  case  with  the  en- 
trance of  a  notion  or  a  group  of  notions  into  conscious- 
ness. If  that  notion  as  a  whole,  is  coincident  with  the 
notions  which  are  just  passing  through  the  mind,  then 
its  effect  is  promoting,  while  its  conspicuity  is  agreeable. 
In  case  of  a  non-coincidence,  however,  then  one  of  two 
things  may  happen.  Are  the  notions  in  progress  of  no 
particular  interest;  then  it  depends  upon  the  subject  of 
the  new  train  whether  they  evoke  a  feeling  of  pleasure 
or  displeasure.  The  dislodgment  of  the  first  notion  does 
not  evoke,  in  itself,  a  noticeable  feeling.  Or  the  notions 
passing  through  the  conscious  mind  are  commanding  the 
interest  of  the  person.  Then  the  attempt  of  any  other 
notion  to  enter  into  consciousness  will  be  noticed  as  a  dis- 
turbance, and  therefore  causes  a  disagreeable  feeling. 
(This  fact  must  be  kept  in  mind,  particularly  in  the  case 
of  compulsory  notions  of  a  blasphemous  or  salacious 
nature.) 

This  is  confirmed  by  experience.  A  friend  is  always 
welcome  under  ordinary  circumstances,  i.  e.,  when  the 
mind  is  occupied  with  notions  of  lesser  importance, 
because  by  his  appearance  the  train  of  thoughts  relating 
to  his  being  and  doings  becomes  realized  after  having 
previously  entered  into  consciousness  without  much  diffi- 
culty. On  the  other  hand,  the  friend  may  call  at  an  inop- 


276  PASTORAL    MEDICINE. 

portune  time,  i.  e.,  at  a  time  when  another  powerful  mass 
of  notions  holds  sway  in  the  vicinity  of  consciousness,  so 
that  your  ideal  train  of  thought  is  unable  to  enter  con- 
sciousness, as  may  be  the  case,  for  example,  if  there  is 
some  important  and  undeferable  work  to  do.  Now 
the  real  train  of  thoughts  which  intrudes  into  conscious- 
ness with  the  friend's  appearance  does  not  meet  anything 
congenial,  and  hence  there  is  a  disturbance  and  a  feeling 
of  annoyance.  Naturally,  the  more  disagreeable  the  in- 
terrupting notion,  the  more  increased  the  annoyance. 
This  notion,  however,  obtains  its  coloring  from  the  pre- 
vailing sentiment  of  mental  life. 

In  this  respect  it  is  not  to  be  denied,  says  Krafft- 
Ebing,  that  original  anomalies  in  character  help  to  ad- 
vance one  or  the  other  compulsory  notion;  for  instance 
the  brooding  over  religious  questions  by  the  bigoted, 
thoughts  of  pollution  by  hysterically  or  hypochondriacally 
inclined,  the  ruminating  whether  something  has  been 
done  right,  be  in  its  proper  place,  by  people  conspicuous, 
from  their  early  youth,  for  their  methodical  ways  and 
their  painful  orderliness. 

As  to  the  subject  of  compulsory  notions  it  is  really 
surprising  how  persons  of  an  altogether  different  position, 
sex,  education,  have  the  same  typical  notions,  and  at  sim- 
ilar periods,  too. 

IV.    SUBJECTS  OF  COMPULSORY  NOTIONS. 

According  to  Westphal,  the  subject  of  compulsory  no- 
tions is  mostly  absurd,  without  traceable  connection  with 
a  previous  impression,  hence  incomprehensible  for  the 
patient.  Yet  the  compulsory  notions  are  not  always  ab- 
surd, as  Krafft-Ebing  has  pointed  out;  they  may  con- 
cern themselves  with  real,  possible  dangers,  with  philo- 
sophical problems  or  mathematical  questions.  Often  the 


SUBJECTS  OF  COMPULSORY  NOTIONS.  277 

subject  is  silly  and  whimsical.  Thus  a  certain  woman, 
every  time  she  met  a  person,  drew  a  mental  picture  of 
that  person  placing  his  head  under  his  arm.  Others 
imagined  all  the  pictures  in  a  room  were  hanging  crooked. 
A  certain  priest  was  perpetually  considering  what  con- 
fusion it  would  be  if,  when  in  church,  he  would  suddenly 
have  to  urinate.  Often  the  subject  is  dreadful,  and  for  the 
patient  perfectly  desperate;  for  instance  if  the  sight  of 
a  knife,  a  rope,  or  an  open  window  arouses  in  them 
the  thought  of  some  deed  of  violence  to  a  person  they 
love. 

Especially  perturbating  are  ideas  of  a  blasphemous 
content,  which  occasionally  are  evoked  by  contrast.  Re- 
ligious souls  are  gravely  tortured  by  this,  especially  if 
blasphemous,  unhallowed  and  salacious  thoughts  force 
themselves  upon  them  at  pious  exercises  and  holy  occa- 
sions, at  Confession  and  Communion,  when  looking  at  an 
image  of  the  Holy  Mother,  or  of  a  saint,  or  at  the  Cross, 
when  reading  religious  books,  or  when  seeing  a  priest, 
a  monk,  or  a  nun,  and  if  they  erroneously  ascribe  the 
cause  for  having  those  thoughts  to  a  secret  inner  de- 
pravity. At  prayer,  for  instance,  may  arise  the  contrast- 
ing notion  "damned,"  instead  of  "hallowed,"  "hell,"  in- 
stead of  "heaven,"  and  it  may  persistently  return  with 
every  attempt  at  reading  aright  the  passage  of  the  prayer ; 
others  again,  when  reading  a  vile  name,  labor  under  the 
compulsory  notion  of  having  applied  the  same  to  the 
divine  Saviour,  the  most  blessed  Virgin,  or  a  saint. 

Often  the  subject  is  salacious.  Thus  some  people  can- 
not pray  in  front  of  an  image  of  the  Holy  Mother  without 
being  tortured  by  the  vilest  salacious  ideas ;  at  times  the 
compulsory  notions  dwell  even  exclusively  on  purely  sex- 
ual ground.  A  certain  woman,  whenever  she  went  out, 
was  harassed  by  the  idea  to  evoke  immoral  thoughts  in  all 


278  PASTORAL    MEDICINE. 

male  persons  she  met ;  another  woman,  onerated  and  in  the 
period  of  retrogradation,  combined  with  originally  simple 
sacrilegious  thought  salacious  ideas  referring  to  the  divine 
persons;  with  other  people  everything  they  see,  read  or 
hear  is  made  to  bear  a  sexual  relation,  even  the  most  tri- 
fling objects.  Legrand  du  Saulle  enumerates  a  large  num- 
ber of  relations  composing  the  subject  of  compulsory  no- 
tions. They  relate  to  God,  the  divine  Mother,  to  the  crea- 
tion, to  nature,  the  duration  of  life,  to  religious  exercises, 
the  eternal  perdition,  the  construction  of  sexual  organs, 
the  process  of  cohabitation,  rape,  etc.  In  order  to 
sketch,  to  some  extent,  the  occasional  subject  of  com- 
pulsory notions,  which  will  be  dwelt  upon  more  fully  in 
a  subsequent  list  of  clinical  cases,  we  must  mention  a  sub- 
ject which  forms  a  link  between  physiological-psychologi- 
cal thinking  and  compulsory  thinking,  which  Dr.  Koch  ex- 
emplifies as  follows:  "Here  is  classed  the,  by  no  means 
rare,  event,  when  a  person  thinks  that  if  he  should  do  or 
omit  something,  said  doing  or  omission  would  be  of  a 
certain  consequence.  For  instance,  one  imagines  that 
some  evil  would  be  conjured  by  his  stepping  upon  the 
joints  of  the  pavement  of  the  sidewalk ;  or  something  will 
happen  if  he  does  not  touch  a  certain  house,  or  a  certain 
tree,  at  a  certain  spot ;  or  that  he  will  die  if  he  does  not 
walk  ten  steps  on  a  certain  lawn;  or  that  something 
dreadful  would  be  in  store  for  him  if  he  did  not  count 
until  100  ere  he  met  somebody  on  the  street;  or  if  he 
would  not  hold  his  breath  till  he  has  reached  a  certain 
spot.  An  otherwise  bright  young  man  was  always  tor- 
tured by  the  thought  that  he  would  commit  a  grave  sin 
by  not  finishing  a  certain  prayer  before  the  clock  had 
ceased  to  strike." 

The  subject  of  compulsory  notions  is  of  a  proteus-like 
variety.    They  are  of  an  especially  fatal  effect  when  they 


SUBJECTS  OF  COMPULSORY  NOTIONS.  279 

refer  to  religious  or  moral  topics.  Especially  sexual,  re- 
ligious, blasphemous,  homicidal  and  suicidal  compulsory 
notions  are  important  for  their  identification  and  correct 
judgment.  Compulsory  notions  of  sexual  or  blasphemous 
contents  have  been  dealt  with  above.  Here  are  some 
more  clinical  cases : 

Mrs.  W.,  thirty-one  years  old;  her  mother  suffered  from 
nervous  disease.  Unhappily  married  eleven  years;  never  had  a 
child.  The  husband  has  squandered  her  estate.  She  brooded 
over  it;  was  suffering  a  few  months  since  from  insomnia,  lack 
of  appetite,  heart-throbbing,  precordial  pressure,  paralgies  in  the 
region  of  the  heart,  faintness  and  weakness.  One  evening, 
while  praying  the  Our  Father,  she  was  besieged  by  blasphemous 
thoughts  ("Ass  that  thou  art;"  curse  words  instead  of  "holy 
Mother").  She  was  greatly  annoyed  and  tried  to  get  over  these 
vile  thoughts  by  praying,  but  it  only  aggravated  matters.  She 
suffered  from  permanent  insomnia;  became  despondent;  she  felt 
as  if  her  heart  had  changed  to  a  stone;  became  restless,  and  was 
looking  in  vain  for  consolation,  first  by  going  to  the  priest,  then  to 
a  physician.  Finally,  the  mere  sight  of  a  holy  picture  sufficed  to 
evoke  sacrilegious  notions.  She  anxiously  avoided  praying. 
Patient  proved  to  be  intelligent,  neurasthenic,  somewhat  hysteric, 
very  anaemic.  Is  thoroughly  aware  of  her  morbid  condition. 
Beyond  traces  of  psychical  anaesthesia,  she  displays  nothing  in 
the  sense  of  melancholy.  The  beginning  of  her  menstruation  is 
accompanied  by  headache;  at  that  period  her  perturbed  state  is 
temporarily  interrupted.  Was  admitted  on  February  20  to  the 
clinic;  was  able  to  occupy  herself  with  religious  subjects  again 
early  in  March;  left  the  treatment  on  March  10,  feeling  well, 
and  has  since  seemingly  remained  in  good  health. 

Compulsory  notions  of  a  sexual  subject  occur  particu- 
larly frequently  to  persons  who  constitutionally  incline  to 
neurasthenia,  and  where  neurosis  has  been  caused  to 
break  out  by  masturbation.  Krafft-Ebing  says:  "The 
appearance  of  compulsory  notions  of  an  erotic  nature, 
while  not  rare,  is  only  secondary  in  view  of  the  multitude 
of  other  notions  not  touching  upon  the  sexual  sphere.  In 
other  cases  where  not  directly  due  to  menstrual  processes, 


28o  PASTORAL    MEDICINE. 

or  temporary  sexual  excitement,  sexual  compulsory  no- 
tions, though  stable,  are  isolated  instances.  Krafft-Ebing, 
however,  mentions  a  case  of  neurasthenia  sexualis  with 
compulsory  notion,  which  case  is  most  important  for 
gauging  similar  cases  in  real  life;  for,  as  Krafft-Ebing 
points  out,  these  conditions  of  psycho-sexual  erethism, 
combined  with  erotic  compulsory  notions,  may  be  mis- 
taken on  superficial  observation  for  chronic  nymphomania. 
The  patient  is  conscious  of  the  morbidity  of  these  condi- 
tions, and  is  most  painfully  annoyed  by  the  sexual 
erethism. 

Case  I. — Mr.  A.,  thirty-five  years  of  age;  business  man, 
of  onerated  family.  Sexual  life  commenced  with  seventeen 
years.  Masturbated,  without  being  seduced,  but  not  to  excess. 
Under  close  surveillance  at  home,  and  educated  in  extreme  moral 
views  to  prudishness,  he,  mostly  from  bashfulness,  abstained  from 
intimate  intercourse  with  women,  masturbating  instead  with  aid 
of  obscene  pictures.  .  .  .  Unhappy  marriage  and  separation. 
He  returned  to  psychical  masturbation,  suffered  from  successive 
pollutions  and  from  neurasthenic  troubles;  after  they  continued 
for  one  and  one-half  years  he  fell  a  victim  to  compulsory  notions. 
He  developed  a  morbid  sense  of  order.  He  could  not  stand  it  if 
books  or  utensils  did  not  lie  in  a  certain  way;  he  was  continually 
afraid  to  make  a  mistake  in  his  bookkeeping  and  was  compelled 
to  figure  unceasingly.  He  was  constantly  ascertaining  whether 
the  door  was  closed;  whether  his  trousers  were  buttoned  up,  etc. 
After  some  weeks  the  compulsory  notions  assumed  an  almost 
exclusively  sexual  direction.  Whatever  he  saw,  even  the  most 
indifferent  thing,  made  him  think  of  sexual  relations.  Although 
without  any  libido,  and  although  the  situations  disgusted  him, 
he  had  to  go  through  them  ad  nauseam.  In  vain  did  he  seek 
refuge  in  solitude  and  in  diligent  work.  Pressure  in  the  head, 
disturbance  of  his  thinking  faculties,  irritability  and  anxiety 
were  ever  on  the  increase.  He  felt  nervously  excited,  suffered 
from  frequent  heart-throbbing;  had  difficulty  in  falling  asleep 
because  of  a  deluge  of  salacious  thoughts,  and  dreamed 
invariably  of  lascivious  situations.  .  .  .  Skull  normal.  No 
sign  of  degeneration.  Nutrition  reduced.  .  .  .  An  ex- 
planation of  his  case  to  him,  together  with  mental  treatment, 


SUBJECTS  OF  COMPULSORY  NOTIONS.  281 

a  mild  cold-water  cure,  preparations  of  bromo,  especially 
natrium  bromatum,  camphor  monobramata,  brought  about 
a  noticeable  amelioration  in  a  few  weeks;  it  took,  however, 
five  months  of  quiet  country  life,  with  treatment  in  accordance! 
to  free  the  patient  of  his  compulsory  notions.  Years  thereafter 
I  met  patient  again.  He  was  in  good  health,  save  some  light 
neurasthenic  troubles.  His  vita  sexualis  was  at  rest. 

Case  2.—M.,  twenty-seven  years  of  age,  sewing  girl ;  never  had 
known  her  parents;  ...  led  a  quiet  and  solitary  life;  never 
patronized  dancing  places ;  badly  nourished ;  lost  flesh ;  presented 
symptoms  of  neurasthenia  cerebro-spinalis  after  a  quite  severe 
rheumatism  accompanied,  eventually,  by  chorea.  Two  years  ago 
became,  without  cause,  afflicted  with  erotic  excitations,  which 
tortured  her  day  and  night.  Nocturnal  pollutions.  In  daytime 
she  could  think  of  nothing  but  of  all  that  might  happen  between 
man  and  woman,  which  caused  her  much  distress  and  fear  of 
losing  her  reason.  She  had  to  draw  a  mental  picture  of  situa- 
tions although  it  was  nauseating  to  her.  Her  free  thinking  was 
increasingly  disturbed.  Whenever  she  read  something,  or  looked 
at  something,  she  had  to  associate  it  with  salacious  ideas;  the 
same  happened  when  she  beheld  men.  Attempts  at  diverting  her 
mind  by  serious  reading  and  hard  work  not  only  failed,  but  ag- 
gravated matters.  Neurasthenic  troubles  were  also  on  the  in- 
crease. Headache,  irritation  of  the  spine  and  the  spinal  marrow, 
restless  sleep,  heart-throb,  etc.  Ailment  moved  in  remissions  and 
exacerbations.  Very  rarely  an  intermission  of  a  few  days  oc- 
curred, when  patient  felt  as  if  relieved  from  a  great  weight.  Ap- 
peared to  be  a  most  decent  person,  and  admitted,  under  tears, 
of  having  masturbated  now  and  then  within  the  last  month  when 
tortured  by  erethismus  genitalis,  thereby  increasing,  however,  her 
troubles,  both  physically  and  mentally.  .  .  .  Day  and  night 
she  claimed  to  be  tortured  by  filthy  thoughts,  always  imagining 
being  raped.  Her  condition  often  makes  her  raving,  when  she 
would  like  to  tear  off  her  clothes.  She  also  says  to  be  contem- 
plating suicide.  She  can  not  understand  why  she  should  suffer 
so,  inasmuch  as  she  never  had  been  sensual,  and  had  been  leading 
a  quiet  and  respectable  life.  Examination  of  the  body  shows  de- 
creased nutrition,  anemia,  sensitiveness  of  the  spine  to  pressure, 
patellar  reflection  much  heightened.  Bromo,  antipyrin,  natr. 
nitricum,  camphor  monobromatic,  codein,  produced  temporary 
relief. 


PASTORAL    MEDICINE. 
Homicidal  and  Suicidal  Notions  by  Compulsion. 

Suicide  notions  may  be  awakened  by  contrast,  like  a 
bolt  out  of  the  blue  sky,  or  they  are  called  forth  in  imita- 
tion, or  by  a  sense  of  disinclination  arising  from  a  bodily 
ill-feeling.  Not  infrequently  these  ideas  force  them- 
selves upon  persons  that  never  have  felt  tired  of  life,  and 
whose  entire  disposition  has  been  averse  to  such  thoughts, 
hence  an  increased  torture  is  caused  thereby. 

The  homicidal  ideas  are  not  seldom  directed  against  the 
most  beloved  kin.  A  frequent  cause  for  such  thought  is, 
according  to  Krafft-Ebing,  the  reading  of  murder  and  of 
sensational  suicide,  whereof  a  yellow  press  furnishes 
painstaking  and  graphic  accounts,  giving  the  most  minute 
particulars  of  the  accident,  or  crime,  possibly  with  pho- 
tographs or  drawings.  The  existence  of  such  thought 
may  cause  the  greatest  compunction,  especially  to  the  re- 
ligiously inclined, 

Anxiety  Caused  by  Compulsory  Notions. 

Heretofore  we  have  looked  upon  these  notions  more 
in  the  light  of  primary  delirium,  and  we  endeavored  to 
arrive  at  an  understanding  of  the  psychical  process,  to  the 
extent  that  it  is  conditioned  by  anomalous  association  and 
combination,  or  by  a  morbid  mood.  The  strain  by  these 
compulsory  notions  upon  the  cerebral  centre  is  so  intense 
and  lasting  that  other  cerebral  centres  must  become  neces- 
sarily irradiated.  The  advent  of  the  compulsory  notion 
is  followed  at  first  by  unrest  and  irritation,  then  by  a  feel- 
ing of  discomfort  and  oppression.  They  increase  to  out- 
ward unrest  and  a  feeling  of  dread,  both  of  which  may  be 
transformed,  by  and  by  or  suddenly,  into  a  condition  of 
violent,  motoric  agitation  and  of  intense  mental  anxiety. 


THE  MANIA  OF  DOUBTING  283 

This  feeling  of  anxiety  is  particularly  favorable  for  a 
frequent  return  of  the  notions,  until  ultimately  the  entire 
mental  life  becomes  governed  by  the  morbid  condition.  In 
science  these  compulsory  notions,  as  caused  by  neurasthe- 
nic anxieties,  are  classed  together  under  the  term  "pho- 
bies."  It  may  happen  that  a  patient  be  finally  in  fear  of  the 
fear.  These  conditions,  which  are  only  troublesome  be- 
cause of  the  indistinctness  of  the  anxious  feeling,  are  of 
no  particular  interest  for  the  priest  in  his  work;  hence 
we  turn  to  those  conditions  where  clear  notions,  coupled 
with  an  anxious  feeling,  are  influencing  and  disturbing 
mental  life.  Hereto  pertain  first  of  all 

The  Mania  of  Doubting  and  Brooding. 

The  mania  to  doubt  is  formed  by  compulsory  notions, 
and  may  or  may  not  be  accompanied  by  an  anxious  feeling. 
In  the  former  category  we  have  the  timid  and  the  scru- 
pulous. The  doubting  mania  develops  slowly,  often  al- 
ready in  childhood.  The  patients  constantly  have  ex- 
treme misgivings;  they  take  things  too  seriously  and 
view  everything  from  the  gloomy  side.  This  malady  is, 
however,  but  one  of  a  thousand  manifestations  of  mental 
oneration.  Hereditary  inclination  to  mental  disease  plays 
here  an  overwhelming,  governing,  part.  Often  the  malady 
remains  unnoticed  for  a  long  time.  At  first  the  mania  con- 
sists of  exaggerated  criticalness  and  childish  timidity. 
The  patient  is  not  sure  of  himself ;  he  is  afraid  of  making 
mistakes,  of  committing  errors;  he  feels  constrained  to 
review  even  his  most  trifling  actions  over  and  over  again, 
and  to  make  the  most  careful  dispositions.  Here,  too,  the 
patient  is  fully  cognizant  of  his  condition. 

According  to  Krafft-Ebing  the  doubting  mania  is 
formed  by  notions  that  are  produced  not  by  any  asso- 


234  PASTORAL    MEDICINE. 

ciation  of  ideas,  but  by  a  physiological  process,  by  internal 
and  direct  irritations  of  the  cerebral  organs  of  imagina- 
tion, For  example,  a  clerk  who  hitherto  has  done  his  figur- 
ing without  any  difficulty  may,  from  overwork,  succumb  to 
the  compulsory  notion  of  not  having  added  correctly  the 
figures  before  him.  Thereupon  he  finds  himself  immedi- 
ately under  the  compulsory  incentive  to  test  the  accuracy 
of  his  addition.  That  this  is  not  a  simple  case  of  an  un- 
certainty as  to  the  sum,  easy  of  explanation,  may  be  de- 
duced from  the  inexplicable  anxiety  accompanying  the 
notion  and  also  because  the  second  addition,  although 
agreeing  with  the  first,  fails  to  satisfy  him  entirely.  He 
has  become  a  victim  of  compulsory  doubts. 

The  same  applies  to  the  well-known  oddities  of  some 
people,  who  never  cease  looking  whether  the  doors  are 
properly  locked,  the  light  really  turned  off;  whether  the 
letters  have  not  been  put  in  the  wrong  envelopes ;  whether 
some  one  has  not  secreted  himself  behind  the  stove,  under 
the  bed  or  in  the  wardrobe.  This  compulsory  doubting  or 
brooding  may  concern  indifferent,  even  silly  or  whimsical 
objects,  but  also  very  reasonable  things,  often  philosophi- 
cal and  religious  questions  and  problems.  The  train  of 
thoughts  which  rules  the  patient  obtains  its  direction  from 
his  degree  of  education  and  from  his  social  position.  These 
forms  of  compulsory  thinking  are  particularly  torturing 
and  perplexing  for  those  religiously  inclined,  if  they  begin 
to  affect  questions  of  religious  or  moral  order.  Hereto  be- 
longs the  entire  group  of  scrupulous  people  who  con- 
stantly are  scrutinizing  all  they  think,  speak  or  do,  and 
who  imagine  a  possible  careless  performance  of  a  deed, 
or  its  omission,  to  have  the  most  absurd  consequences. 

Such  morbid  doubtfulness  may  have  an  oppressing, 
discouraging  and  depressing  effect  upon  a  timid  priest, 
should  this  notion  creep  into  his  performance  of  holy 


THE  MANIA  OF  DOUBTING.  285 

functions,  taking  the  shape  of  compulsory  verification  and 
recapitulation,  in  pronouncing  certain  words  and  for- 
mulas, for  instance  when  reciting  the  words  of  absolution 
and  consecration.  In  such  cases  matters  are  aggravated 
by  the  fear  to  jeopardize  the  essential  value  of  the  function 
by  a  violation  of  certain  clear  and  binding  regulations. 
Thus  it  may  happen  that  the  "ego,"  having  lost  all  firm 
support,  becomes  swallowed  up  in  doubt.  This  brood- 
ing and  doubting  generates  that  morbid  precision  which 
the  patient  uses  as  a  staff  to  steady  him  on  the  shaking 
soil.  Constant  recapitulation  of  the  daily  office,  growing 
desire  for  delay  of  the  same  and  finally  giving  it  up  en- 
tirely, is  not  rarely  the  sad  upshot  of  a  like  condition.  To 
many  a  priest  the  celebration  of  holy  Mass  is  most  painful 
because  he  once  made  a  mistake,  and  he  is  constantly 
afraid  of  making  it  over  and  over  again,  and  therefore 
dreads  the  reading  of  the  Mass  because  of  that  thought. 
Again,  the  always  recurring  thought,  whether  he  had 
been  possessed  of  the  earnest  intention  to  act  in  the  sense 
of  the  Church,  may  transform  for  a  clergyman  the  sim- 
plest priestly  act  into  martyrdom. 

The  late  Ballerini  used  to  place  these  timid  priests  in 
three  classes:  I.  Mementistae,  who  can  not  get  time 
enough  to  think  of  all  the  people  they  intend  to  pray  for. 
2.  Consecristae,  who  are  in  steady  fear  of  not  having 
uttered  the  words  of  consecration  clearly  enough  and 
pointedly  enough,  who  therein  are  careful  to  excess.  At 
times  some  suffer  on  that  account  from  real  fright,  heart- 
throbs and  trembling.  3.  Fragmentistae,  who  scrape 
and  rub,  against  all  rhyme  and  reason,  until  not  only  pos- 
sible particles,  but  also  the  least  of  the  numerous  specks 
of  dust,  caused  by  their  own  silly  manipulation,  has  been 
removed.  Hereto  may  be  added  the  Intentionistae,  who 
are  in  difficulties  because  of  intentio  consecrandi  et  ap- 


286  PASTORAL    MEDICINE.        » 

plicandi,  and  the  Rubricistae,  who  are  troubled  with  all 
kinds  of  misgivings  about  the  rubrics,  especially  about  the 
Actio. 

What  priest  has  not  had  experiences  with  penitents 
who  are  constantly  afraid  of  not  having  been  truthful,  of 
having  forgotten  something,  of  not  having  stated  suffi- 
ciently number  and  circumstances,  and,  finally,  of  not 
having  been  penitent  enough ;  or,  after  receiving  the  holy 
Eucharist,  of  having  partaken  thereof  in  unworthiness. 
Others,  again,  are  in  doubt  whether  they  have  given  cor- 
rect evidence  in  court,  whether  they  have  paid  a  debt,  ful- 
filled a  promise,  written  a  letter  properly,  or  that  they 
have  said  something  offensive,  etc.  A  certain  judge  was 
constantly  haunted  by  fear  of  some  warrant  not  having 
been  revoked,  by  oversight ;  hence  time  and  again  he  had 
to  make  sure  whether  the  prisoner  had  been  really  dis- 
charged. These  unfortunates  are  aware  of  the  silliness  of 
their  doings ;  they  do  their  best  to  free  themselves  of  these 
troublesome  intruders  of  the  compulsory  ideas;  they  ac- 
knowledge that  they  owe  unconditional  obedience  to  their 
adviser  particularly  where  religious  matters  are  concerned, 
but  the  one  and  prime  idea,  is,  after  all,  that  something 
most  important  might  be  the  matter,  the  whole  reputation 
may  depend  on  it  ultimately,  it  might  be  wrong  after  all 
and  jeopardize  salvation!  This  idea  is  more  powerful 
than  all  reasonable  considerations,  teachings  and  admoni- 
tions. Those  religiously  inclined  feel  constrained  to  ac- 
cuse themselves  because  of  the  points  in  doubt ;  they  ask 
for  advice,  only  to  doubt  again  and  more  than  ever. 

V.    VARIOUS  COMPULSORY  CONDITIONS. 

The  multitude  of  different  notions  filling  the  mind  of 
those  afflicted  with  the  brooding  and  doubting  mania  is 


VARIOUS  COMPULSORY  CONDITIONS.   287 

shown  by  the  following  classification  by  Ball:  i.  The 
philosophers,  who  occupy  themselves  with  the  great  meta- 
physical problems  and  are  always  brooding  over  the  con- 
ception of  deity,  universe,  creation,  etc.  2.  The  realists, 
who  think  more  or  less  of  trivial  things.  A  certain  speci- 
men of  this  type  was  seriously  occupied  with  the  question, 
Why  is  the  stove  near  the  wall  and  not  in  the  middle  of  the 
room  ?  Then  we  have  (3)  the  scrupulous,  who  are  always 
reproaching  themselves,  no  matter  what  they  have  done. 
4.  The  timid,  always  afraid  of  having  blundered,  and 
(5)  the  morbid  mathematicians,  who  never  cease  figuring, 
who  pay  attention  to  nothing,  are  interested  in  nothing, 
but  the  number  of  objects,  no  matter  what  they  are.  It 
happened  with  one  of  these  counting  fiends  that  he  even 
kept  tab  of  the  number  of  sentences  which  he  used  when 
speaking  on  some  subject ;  others,  when  entering  a  room, 
count  the  pictures  on  the  wall  or  the  books  on  the  shelves. 

These  few  examples  are  sufficient  to  show  how  far 
these  compulsory  ideas  may  go.  The  brooding  mania 
appears  at  times  in  aggravated  form  when  the  intruding 
ideas  strike  the  mind  in  the  shape  of  useless  inquiries. 
This  kind  of  mental  rumination  may  be  directed  either 
to  indifferent  themes  or  most  important  ones.  Dr.  Koch 
mentions  the  case  of  an  educated  person  who  constantly 
pondered  over  the  following  question:  "The  equivalent 
for  our  apple  is,  in  Italy,  the  orange ;  for  our  pear,  the  fig ; 
for  our  quince,  the  lemon ;  but  what  is  the  equivalent  for 
our  prune?"  Auto-mechanically,  like  an  endless  screw, 
a  morbid  motive  forces  itself  into  the  thinking  process 
by  connecting  and  transforming  all  conceived  notions  and 
thoughts  into  interrogatory  sentences. 

In  dismal  monotony  questions  are  obtruding  them- 
selves such  as:  What  is  God?  Is  there  a  God?  What  is 
eternity?  Why  does  the  devil  exist?  How  was  the  world 


s88  PASTORAL    MEDICINE. 

made  ?  Why  am  I  here  ?  Why  do  people  exist  ?  Why  is 
there  but  one  sun  ?,  etc. 

As  we  have  seen  above,  the  simple  compulsory  thinking 
may  by  degrees  be  developed  into  compulsory  conditions, 
manifesting  themselves  in  "compulsory  feelings,  in  com- 
pulsory fears."  The  thought  of  having  injured  the  life 
or  the  health  of  other  people  by  dropping  a  match,  a  pin,  a 
piece  of  broken  glass,  or  by  making  an  inkstain,  compels  a 
picture  of  the  most  absurd  consequences.  For  example,  a 
person  was  stricken  with  the  compulsory  fear  of  getting 
diarrhoea  every  time  she  would  attend  Mass;  the  upshot 
was  that  she  finally  stayed  away  from  church  altogether. 
A  priest  had  the  compulsory  fear  of  robbing  his  fellow 
priest  who  paid  him  a  visit.  A  man,  when  walking  in  the 
street  was  fearful  to  step  on  a  child.  To  ward  off  this 
thought  he  counted:  Don't  crush  one  child,  don't  crush 
two  children,  etc.  A  case  where  compulsory  brood- 
ing, mostly  over  religious  questions,  is  followed  by  the 
compulsory  notion  of  pollution  by  metals  or  animals,  is, 
according  to  Krafft-Ebing,  a  special  morbidity  within  the 
whole  group  of  compulsory  notion,  but  we  enumerate  it 
here  for  the  sake  of  completeness  and  because  it  is  proven 
by  experience,  that  doubting  mania  and  the  fear  of  touch- 
ing metals,  etc.,  may  develop  jointly.  To  the  doubting 
mania,  the  folie  du  doute,  corresponds  in  the  emotional 
mania  the  folie  de  toucher.  Although  in  the  possession  of 
his  reason  and  clearly  aware  of  the  silliness  and  the  mor- 
bidity of  his  fear,  the  patient,  nevertheless,  declares  to 
be  afraid  of  touching  a  coin,  a  doorknob,  etc.,  because  it 
may  be  poisoned  or  he  may  thereby  injure  his  own  health 
or  that  of  some  one  else.  The  alienist  Falret  states  that 
the  variety  of  fears,  brought  to  light  every  moment  by 
morbid  notions,  is  beyond  any  estimate. 

Dr.  Morel  tells  of  a  sexton  who  for  twenty-five  years 


CAUSES  OF  COMPULSORY  CONDITIONS.***) 

was  afraid  of  touching  his  staff;  an  appellate  judge,  who 
never  entered  a  room  except  with  one  hand  in  the  pocket 
of  his  coat,  who  never  suffered  any  one  to  enter  his  room 
but  received  his  visitors  in  the  corridor,  and  who  never 
crossed  the  streets  except  on  tiptoes.  Some  people  think  of 
hydrophobia  when  beholding  a  cat  or  dog;  others  must 
think  of  verdigris  when  looking  at  a  copper  vessel  or  a 
metal  doorknob.  The  patients  consider  these  ideas  very 
stupid,  but  are  unable  to  free  themselves  of  the  com- 
pulsion. Compulsorily  they  employ  measures  for  pre- 
caution or  safety  that  are  most  troublesome.  A  certain 
woman  had  to  wash  her  hands  more  than  200  times  a  day. 
Others  are  continually  dusting  the  furniture  or  disinfect- 
ing the  rooms.  Finally  we  must  mention  the  dread  of 
some  particular  place,  more  or  less  a  consequence  of  an 
abnormal  mental  condition  caused  by  compulsory  ideas. 
Although  the  outer  senses  are  engaged,  yet  the  whole  pro- 
cess is  nothing  but  the  creation  of  an  overirritated  imag- 
ination. Inasmuch  as  the  mind  is  dependent  on  the  offer- 
ings of  imagination,  it  is  inevitable  that  the  awful  subject 
of  the  thoughts  evokes  the  feeling  of  fear.  Thus  the  fol- 
lowing thought  may  occur  to  a  person  about  to  enter,  for 
instance,  an  open  square :  Now  I  shall  have  an  accident,  I 
shall  faint.  The  patient  is  conscious  of  the  silliness  of 
this  fear,  he  tries  to  be  reasonable,  to  banish  his  fear,  all 
in  vain.  His  case  is  like  that  of  a  person  suffering  from 
vertigo.  No  matter  how  often  he  may  reason  here  is  no 
ground  for  any  fear,  the  fear  remains  in  effect ;  notwith- 
standing the  bidding  of  his  will,  the  giddy  must  submit 
to  the  feeling  although  he  pronounces  it  to  be  false. 

VI.     CAUSES  OF  COMPULSORY  CONDITIONS. 

One  of  the  main  causes  for  the  generation  and  continu- 
ance of  the  compulsory  ideas  and  for  their  repeated  re- 


PASTORAL    MEDICINE. 

turn  is  the  morbid  accentuating  of  feeling.  The  reason 
why  that  mood  exists  lies  principally  in  the  egotism  of  a 
person,  because  he  pays  undue  attention  to  a  thought  or 
train  of  thoughts  which  touch  upon  his  sphere  of  interest ; 
this  explains  also  why  the  compulsory  notions  derive  their 
color  from  the  position,  the  education,  the  sentiment  of 
the  patients ;  this  explains  why  the  subject  of  the  com- 
pulsory notion  is  proteus-like  diversified.  The  feeling  of 
anxiety,  which  accompanies  the  compulsory  notion  be- 
comes intensified  by  organic  anomalies  or  by  an  abnormal 
disposition  of  character.  These  compulsory  conditions, 
which  for  the  most  part  develop  on  neurasthenic  soil, 
hence  may  be  called  Neuropsychose,  are  favored  by  the 
morbid  impressionability  common  to  neurasthenia,  the  re- 
duced thinking  power  and  will  power,  which  renders  it 
difficult  to  fight  the  compulsory  idea  by  means  of  sponta- 
neously called  forth,  liberating  ideas,  by  associating  them ; 
the  compulsory  notion  dealing  with  the  welfare  or  the  evil 
of  one's  self  or  of  others  is  promoted  by  vivid  emotions ;  if 
of  an  organic  case  it  is  enhanced  by  physical  sensations. 
But  in  particular  it  is  the  fear  that  the  compulsory  no- 
tions may  compel  the  patient  to  do  something  which  may 
compromise  him,  hold  him  up  to  ridicule  or  even  incrim- 
inate him,  it  is  that  fear,  keeping  him  in  a  permanent  con- 
dition of  emotional  irritation,  which  is  thwarting  the  cure 
of  his  nervous  debility.  This  fear  is  essentially  furthered 
by  the  simultaneous  decrease  of  capability  and  power  of 
resistance  incidental  to  neurasthenia.  Dr.  Kaan  points 
to  a  similar  apparition  in  animal  life,  the  shyness  and 
faint-heartedness  of  horses.  If  the  horse  fails  to  move  the 
wagon  on  his  first  efforts,  it  begins  to  tremble,  to  snort, 
and  does  not  respond  to  the  whip.  The  failure  of  the  very 
first  effort  suffices  for  some  horses  to  behave  that  way, 


CAUSES  OF  COMPULSORY  CONDITIONS.agi 

others  only  after  several  trials.  In  the  same  manner  does 
a  person,  aware  of  his  lessened  capability,  become  faint- 
hearted ;  this  result  is  the  same  whether  he  has  been  con- 
vinced of  his  inability,  or  lessened  ability,  through  a  real 
failure  or  only  on  account  of  his  depressed  mood. 

The  compulsory  notion  to  verify,  to  -constantly  scruti- 
nize, every  act,  deemed,  perhaps  rightly,  of  importance,  as 
may  be  the  case  with  judges,  priests,  etc.,  is  caused  by  a 
feeling  of  lessened  energy,  combined  with  a  distrust  of 
his  memory  on  part  of  the  neurasthenics.  The  repro- 
ducing power  of  the  memory  being  weakened,  it  does 
not  readily  answer  all  doubts  and  misgivings,  hence  the 
anxious  doubts  are  exacerbated.  Worst  of  all  if  the  neu- 
rasthenic has  actually  had  occasion  to  satisfy  himself  of 
the  untrustworthiness  of  his  memory;  in  that  case  he 
never  eases  his  mind,  even  after  his  hardest  thinking  has 
failed  to  reveal  an  offense  which  may  account  for  his 
troubled  conscience.  The  precordial  pressure,  a  frequent 
symptom  of  neurasthenia,  continues  to  prevail ;  memory, 
which  lied  once  may  lie  again.  Herefrom  develop  the  im- 
pulses to  verify.  One  example  by  Dr.  Kaan:  The  cor- 
responding clerk  of  a  large  business  house,  who  had  neu- 
rasthenia from  overwork,  once  caught  himself  writing  a 
wrong  figure ;  henceforth  he  re-read  every  letter  innumer- 
able times  before  posting  it ;  but  this  failed  to  quiet  him. 
He  reviews  his  day's  work,  the  least  little  instance  which 
he  can  not  exactly  recall  assumes  in  his  apprehensive 
imagination  proportions  of  most  terrible  neglect  of  duties, 
which  he  can  not  recall  to  his  mind.  Finally  he  spends  his 
whole  leisure  time  examining  his  conscience  in  this 
manner. 

A  certain  priest  in  saying  his  office  had  always  to 
think  of  the  said  prayers,  if  he  succeeded  in  remember- 
ing every  part  of  them  then  he  would  continue  praying, 


292  PASTORAL    MEDICINE. 

if  not  he  would  repeat.  Here  was  present  the  impulse  to 
repeat  also  when  doing  his  other  priestly  work.  To  retain 
a  prayer  in  his  memory  he  hit  upon  the  most  whimsical 
expedients.  So  he  imagined  the  words  of  the  absolution 
to  be  printed  with  golden  letters  and  grouped  now  in  this 
now  in  another  order ;  he  painstakingly  marked  the  single 
psalms  in  his  breviary,  or  he  placed  a  certain  article  on  a 
particular  spot  after  having  read  a  portion  of  his  prayer. 
These  few  examples  will  show  sufficiently  how  compul- 
sory notions  are  furthered  by  neurasthenic  conditions. 

The  more  these  compulsory  notions,  morbid  fears,  rule 
the  patient's  inner  life,  the  more  does  his  outward  life 
present  itself  as  a  chain  of  morbid  compulsory  acts  in- 
tended for  the  greater  part  as  defense,  but  also  as  a 
safety  means.  First  of  all  these  patients,  afraid  of  the 
fear,  avoid  any  situation  apt  to  bring  those  dreaded  im- 
pulses to  their  attention,  the  pious  refrain  from  devo- 
tions, the  suicide  candidate  shuns  the  sight  of  weapons; 
the  woman  afflicted  with  compulsory  erotic  thoughts 
anxiously  avoids  being  left  alone  with  a  man ;  those  afraid 
of  making  themselves  ridiculous  in  society  become 
misanthropical  hermits,  and  finally  he  who  thinks  him- 
self capable  of  incriminating  himself  by  writing,  will  be- 
come frightened  by  the  sight  of  a  piece  of  paper.  Those 
afflicted  with  compulsory  notions  are  prone  to  devise  all 
sorts  of  ways  and  means  to  banish  the  thought.  Thus  a 
woman  patient  could  get  rid  of  her  ideas  by  putting  them 
down  on  paper  ;  it  quieted  her. 

Another  patient  went  through  certain  motions  with  his 
head  or  with  his  hands  or  feet;  another  counted  up  to  a 
certain  number,  or  walked  for  a  certain  number  of  steps, 
or  put  his  hand  on  a  certain  object  a  given  number  of 
times.  A  girl  escaped  her  blasphemous  thoughts  by  ex- 
claiming: I  don't  want  to.  A  gentleman,  in  order  to  rid 


CAUSES  OF  COMPULSORY  CONDITIONS.293 

himself  of  blasphemous  thoughts,  wrote  and  then  read 
innumerable  times :  I  won't  commit  a  mortal  sin,  cursed 
be  those  thoughts. 

A  patient  afflicted  with  blasphemous  thoughts  about  the 
mother  of  the  Lord,  succeeded  in  banishing  them  by  ex- 
claiming: Our  beloved  Lady  of  Victory  at  Paris, 
whereby  the  word  Paris  appeared  to  him  as  his  salvation.  A 
young  man  used  to  expectorate  before  partaking  of  Holy 
Communion  in  order  to  banish  the  thought  of  having 
broken  his  fast.  These  compulsory  acts  directed  against, 
and  emanating  from,  compulsory  notions  are  on  a  par 
with  compulsory  omissions,  refraining  to  read  certain 
books,  to  open  a  letter,  etc.  The  following  interesting 
case  may  serve  as  an  analysis  of  the  entire  morbid  process. 

An  art  student,  twenty-one  years  old,  gravely  onerated, 
ascribed  a  saving  influence  to  certain  words.  To  conjure  a  mis- 
fortune he  said  the  words:  grave,  shroud,  bier,  etc.  Not  being 
different  in  acts  and  customs  from  other  people  he  used  to  be 
in  company  with  friends.  One  day  they  spoke  jestingly  about 
the  number  13.  At  once  the  following  idea  passed  through  his 
mind:  if  13  be  really  an  ominous  number,  then  it  is  a  pity  that 
God  has  created  13,  that  there  is  a  period  of  13  years,  that  there 
was  a  13  in  the  beginning,  and  that  13  will  remain  in  eternity. 
Very  well,  then.  At  the  beginning  13,  at  the  end  13,  and  13  in 
eternity.  Why  shirk  misfortune?  He  mentally  formed  the 
formula:  "God  13,  at  the  beginning  13,  in  eternity  13."  This 
idea  rules  him,  He  repeats  his  formula  every  minute,  hence 
can  not  think  of  anything  else.  For  a  brief  time  his  formulas 
satisfied  him,  but  only  too  soon  had  he  to  look  for  new  conjura- 
tions. Sometimes  he  touched  his  dressing-case  13  times  in  suc- 
cession before  going  to  bed,  or  13  different  things  that  were  scat- 
tered in  his  room.  By  and  by  he  executed  these  13  touches 
several  times  in  succession;  ultimately  he  staid  awake  all  night, 
running  around  in  his  room  and  touching  things  13  times. 
Henceforth  13  is  foremost  in  his  thoughts.  He  never  uses  13 
words  in  a  sentence.  Has  he  written  twelve  words  without 
finishing  the  sentence,  then  he  adds  at  least  two  more  words,  lest 
the  13  would  beget  some  misfortune.  The  same  when  he  talks.  In 


294  PASTORAL    MEDICINE. 

order  to  avoid  sentences  with  13  words  he  counts  them.  The 
following  is  taken  from  a  memorandum  by  him : 

"  Unable  to  overcome  this  notion  by  reason  I  make  use  of  the 
number  13.  Speaking  unto  myself,  as  if  the  world  were  mine,  I 
said  one  evening:  If  I  should  do  between  to-day  and  to-morrow 
a  single  superstitious  thing,  then  all  stars  which  I  behold  shall 
be  13.  At  the  same  time  I  imagined  all  stars  above  my  head  to 
be  transformed  in  the  number  13,  composed  of  innumerable 
particles,  of  which  the  essence  was  13.  I  did  not  quite  under- 
stand the  meaning  of  a  star  13,  but  I  was  so  afraid  of  the  13 
that  I  did  not  perform  any  silly  acts  until  the  other  morning. 
The  process  having  been  successful  I  abused  it.  'God  be  13  if 
I  do  something  superstitious'  another  time. 

"  The  notion  of  God  13  was  not  any  more  sensible  than  the 
notions  of  the  stars  being  in  their  essence  13.  However,  sense 
or  nonsense,  I  did  not  object.  The  notion  of  God  kept  me  in 
awe  which  sufficed  for  a  time  to  prevent  my  doing  foolish  acts." 

Not  less  queer  are  the  means  used  against  erotic  com- 
pulsory ideas.  A  gentleman  tried  to  correct  them  by 
counter  thoughts ;  he  took  pains  to  picture  women  to  him- 
self as  skeletons  and  their  limbs  as  burned  and  charred. 
He  knew  very  well  that  these  means  would  not  help,  being 
against  all  reason,  and  the  ultimate  failure  aggravated 
matters.  Even  in  case  of  success,  the  patient  gets  fagged 
out  in  the  degree  of  the  expended  resistance.  Finally  he 
resists  no  longer,  he  loses  all  his  will  power  as  against  the 
compulsory  notions,  hence  always  the  same  senseless  act 
over  and  over  again. 

It  is  easily  perceived  how  this  peremptory  compulsion 
tires  out  the  mind.  Bad  enough  to  be  hounded  by  a  com- 
pulsory idea  for  a  few  days  only,  but  what  an  unbearable 
burden  to  serve  for  years  as  football  to  such  a  tyrannical 
influence.  A  failure  of  these  defensive  efforts  will  exer- 
cise a  particular  hurtful  and  depressing  effect  upon  a 
very  religious  and  morally  pure  soul.  By  the  fear  of 
such  blasphemous  ideas  taking  root  in  the  mind  they  are 


CLINICAL  CASES.  295 

involuntarily  called  into  consciousness ;  the  upshot  of  that 
one  blasphemous  thought  being  that  all  objects,  asso- 
ciated with  the  idea  (the  image  of  a  saint,  etc.),  tend 
to  reproduce  the  fear  and  with  it  the  thought.  The  circle 
becomes  larger  and  larger.  The  religiously  inclined  will 
fail  like  him  who  looks  at  the  sun  intensively.  Over- 
straining his  eyes  he  will  see  black  spots  for  some  time. 
To  such  spots  may  be  likened  the  blasphemous  or  sala- 
cious thoughts.  The  more  one  cares  for  his  salvation, 
the  more  horrified  he  is  by  an  unclean  thought  or  impulse. 
While  the  indifferent  soon  dismisses  these  thoughts,  the 
overzealous  Christian  will  concentrate  his  whole  energy 
to  fight  and  suppress  them;  but  it  has  just  the  op- 
posite effect.  His  resistance  against  intercurring  asso- 
ciation, and  to  even  a  greater  extent  his  self-confidence, 
has  been  shaken  by  sexual  neurasthenia,  he  enters  into 
the  fray  with  hesitation,  his  precordial  pressure  makes 
him,  from  the  start,  despair  of  an  ultimate  victory. 

The  simple  and  compound  notions,  this  conglomeration 
of  compulsory  sentiments,  affections  and  impulses,  with 
corresponding  acts,  afford  a  view  into  mental  conditions 
that  are  surprising,  and  more  prevalent  than  many  would 
believe.  It  is  of  vital  interest,  not  only  for  the  priest,  but 
also  for  the  layman,  to  find  an  explanation  for  these  con- 
ditions and  to  overcome  the  alarm  resulting  therefrom. 

VII.     GENERAL  VIEW  OF  COMPULSORY  NOTIONS 
AND  CONDITIONS.    CLINICAL  CASES. 

In  order  to  gain  a  general  view  of  shape,  substance, 
development  and  last  stage  of  compulsory  notions  and 
conditions,  and  in  order  to  gain  a  basis  for  practical  de- 
duction at  the  same  time,  some  additional  clinical  cases 


296  PASTORAL    MEDICINE. 

may  be  enumerated,  wherein  are  crowded  together  all  their 
symptoms  to  an  extent  that  it  would  look  as  if  these 
"cases"  had  been  especially  constructed.  Yet  it  must  be 
admitted  that  these  symptoms  may  well  be  found  on  one 
and  the  same  person,  as  we  have  seen  already. 

A  ten-year-old  girl,  about  to  make  a  pilgrimage,  was  afraid 
she  would  forget  to  state  a  certain  sin  at  Confession.  To  calm 
herself,  she  endeavored  to  memorize  her  sins  in  certain  order 
and  repeated  them  time  and  again  in  her  mind.  She  went  to 
Confession  greatly  perturbed  and  was  even  more  excited  there- 
after. She  never  could  rid  herself  of  the  thought  of  having  con- 
cealed, accidentally  or  even  purposely,  a  sin,  although  both  her 
memory  and  her  conscience  told  her  otherwise.  She  was  aware 
of  the  silliness  of  her  fear,  yet  she  could  not  free  herself  of  it, 
nor  overcome  her  doubt.  Patient  describes  her  condition  thus : 
"  I  went,  after  Confession,  to  Holy  Communion  in  a  state  of 
the  most  awful  perturbation.  When  the  priest  offered  me  the 
holy  Host,  the  idea  struck  me,  I  should  have  to  bite  into  the 
Host.  After  closing  my  mouth  I  really  thought  I  had  bitten 
the  Host  in  two.  I  did  not  dare  open  my  lips  for  fear  I  might 
spit  out  one  of  the  parts.  My  perturbation  was  intensified  by 
my  thinking  of  having  perhaps  done  all  that  on  purpose,  of 
having  wilfully  harbored  these  thoughts.  I  experienced  the  most 
terrible  mortal  anguish.  The  horrible  thought  of  having  com- 
mitted a  sacrilege,  on  purpose  at  that,  occupied  my  whole  mind. 
To  get  rid  of  that  thought  and  to  find  consolation,  I  analyzed 
my  whole  action,  I  pondered  over  it,  but  a  moment  of  peace  had 
hardly  arrived  when  the  thought  recurred  with  renewed  force : 
Thou  hast  committed  a  sacrilege.  This  train  of  thought  per- 
secuted me  stubbornly  until  I  was  fifteen,  notwithstanding  that  I 
realized  its  absurdity — at  times  it  tortures  me  even  now.  This 
persistent  and  horrifying  idea  is  sure  to  come  back  to  me 
every  time  I  go  to  Confession  and  Communion.  Other  persons, 
too,  may  become  afflicted  with  kindred  ideas  upon  receiving  the 
holy  sacraments,  but  theirs  certainly  do  not  adhere  to  conscious- 
ness with  such  persistency.  I  don't  dare  to  read  the  examination 
of  conscience  in  a  prayer  book,  lest  I  might  think  of  having  com- 
mitted all  the  sins  enumerated  therein.  At  Confession  I  suffer 
mortal  pain.  Every  time  I  answer  the  priest's  question  I  must 
think:  Now  this  was  wrong,  I  denied  instead  of  affirming;  what 


CLINICAL  CASES.  297 

I  said  wasn't  right.  My  scruples  almost  kill  me.  Although  the 
priest  assured  me  that  I  did  say  yes,  I  still  kept  on  doubting 
that  he  might  have  misunderstood  my  no  for  yes. 

"  At  the  same  time  I  was  worried  with  solving  some  questions, 
which  took  a  hold  on  me  with  great  intensity  and  persistence.  How 
is  it  possible  for  a  deceased  to  reach  the  other  world?  How  did 
the  world  spring  into  existence?  What  is  eternity?  How  did 
I  spring  into  existence?  The  Scriptures  would  not  suffice  me. 
I  pondered  for  years  over  these  questions  that  kept  worrying  me. 
Even  if  I  did  succeed  in  forgetting  them  for  a  day,  they  were 
sure  to  return.  Then  my  brain  would  surprise  me  all  at  once 
with  angry  thoughts,  even  calling  God  names,  so  that  I  acted 
as  if  in  despair.  I  beat  my  head,  butted  it  against  the  wall,  I 
raised  my  hands,  crying  out,  No,  no,  I  did  not  want  to  say  that 
I  did  everything  to  banish  the  thought,  but  what  a  vain  effort! 
When  writing  a  letter  I  feared  of  having  written  down  some 
nonsense,  of  having  made  mistakes  in  spelling  or  in  punctuation. 
Hence  I  would  start  the  same  letter  over  again,  each  time  with 
other  sentences,  other  words,  and  thus  could  never  come  to  a  fin- 
ish. Having  quieted  down  I  re-read  the  letter  as  I  had  written  it 
first,  and  found  it  to  be  free  of  any  mistakes.  But  as  soon  as  I  had 
mailed  that  letter,  then  my  doubts  came  back  to  me  again.  Have 
I  penned  all  I  intended  to  write,  would  the  letter  be  intelligible? 
All  these  queer  thoughts  attained  a  certain  degree  of  force,  and 
then  would  vanish.  However,  they  kept  me  in  a  constant  par- 
oxysm. 

"  At  our  farm  there  is  a  chest  containing  cruets  with  altar  wine, 
used  in  the  adjoining  chapel.  I  always  passed  that  chest  in  a 
roundabout  way,  fearing  to  soil  the  cruets.  To  take  some  linen 
out  of  the  same  chest  is  beyond  me;  I  might  soil  the  linen  and 
thereby  the  cruets.  Motionless  I  remain  seated  in  my  room  for 
hours,  stiff  and  motionless  like  a  statue,  afraid  of  touching  any- 
thing. When  walking  on  the  street  I  am  hounded  by  the  idea  a 
brick  may  fall  down  from  the  roof  and  kill  me.  I  therefore  often 
walk  in  the  middle  of  the  street,  or  changing  from  right  to 
left  side,  always  in  the  greatest  excitement.  Once  at  Holy 
Communion  I  had  the  impression  that  the  Host  were  lying  on  the 
floor  and  that  I  were  to  step  on  it  with  force.  The  most  annoying 
job  for  me  is  to  go  shopping;  when  paying  I  have  to  count  and  re- 
count the  money,  to  ask  repeatedly,  is  this  a  dime?  Is  it  perhaps  a 
counterfeit?  Having  closed  the  door  of  the  store  behind  me,  then 
I  again  imagine  of  having  paid  too  little.  I  go  back  and  lay 


298  PASTORAL    MEDICINE. 

quickly  down  on  the  counter  some  coins  to  ease  my  conscience. 
My  doubting  was  steadily  gaining  ground;  it  followed  in  the 
wake  of  almost  every  act.  Once  when,  after  the  prevailing  fash- 
ion, I  wore  a  dress  with  a  train,  I  was  afraid  somebody  might 
stumble  over  my  train,  break  his  legs  or  receive  fatal  injury;  my 
vanity  would  make  me  a  criminal.  I  could  not  bear  it  any  longer, 
so  I  took  off  that  dress.  The  most  dreadful  thing  for  me  was  to 
wear  a  new  dress.  I  would  not  wear  it  in  the  street  lest  I  might 
soil  it  by  brushing  against  something.  When  crossing  a  bridge 
I  would  keep  in.  the  middle,  fearing  of  otherwise  pushing  some 
one  into  the  river.  When  doing  kitchenwork,  or  when  I  had  to 
shake  hands  with  a  visitor  (which  I  always  liked  to  avoid),  then 
I  thought  my  hands  were  soiled  and  dirty,  and  I  would  wash 
them  for  hours.  I  knew  it  was  absurd,  yet  I  could  not  turn 
from  the  wash  basin.  When  the  lights  were  lit  I  was  afraid  they 
would  put  my  dress  afire.  In  such  a  state  it  often  seemed  to  me 
I  must  set  my  dress  afire,  that  I  may  ascertain  with  my  own 
eyes  that  something  is  afire  and  so  gain  peace.  I  can't  explain 
this  interior  compulsion,  this  magic  force.  I'm  very  much  afraid 
that  some  time  it  will  control  me  to  such  an  extent  as  to  make  me 
cause  a  great  misfortune." 

Krafft-Ebing  continues :  "  When  I  explained  to  her  that  the 
imagination  was  no  fault  of  her  own,  but  caused  by  compulsory 
notions  and  by  compulsory  actions,  hence  a  pathological  condi- 
tion, she  could  not  find  enough  words  to  thank  me.  Almost 
always  she  knows  in  advance  when  a  paroxysm  is  coming.  Her 
mental  agony  is  greatest  when  her  bodily  condition  is  not  har- 
monious, when  some  parts  of  her  body  are  aching.  The  par- 
oxysm is  introduced  by  violent  choking  and  strangulation,  by 
an  intensive  strain  of  different  muscles,  a  burning  sensation  at  the 
crown  of  the  head,  a  lasting  sensation  of  the  brain  being  frozen 
and  becoming  petrified.  All  these  sensations  favor  the  ad- 
vent of  compulsory  notions.  When  traveling  or  when  in  agree- 
able company,  however,  she  gets  a  relative  rest,  then  she  has  a 
feeling  as  if  everything  disagreeable  had  been  removed  from  her 
brain;  then  she  can  calmly  reflect  on  her  queer  condition.  She 
is  kept  conscious,  however,  to  be  on  her  guard,  for  the  terrible 
doubt  and  a  chorus  of  the  most  horrible  compulsory  notions  are 
ever  lurking  and  lying  in  ambush.  Patient  is  of  intelligent  appear- 
ance; her  eyes  are  neuropathic.  But  for  a  certain  nervous  rest- 
lessness and  awkwardness  in  the  intercourse  with  others,  there 


CLINICAL  CASES.  299 

is  nothing  to  betray  her  grave  malady.  Her  psychical  and  neuro- 
pathic ailments  were  considerably  lessened  after  cold  ablutions 
and  bromide  of  potassium  3-4.0  a  day.  "The  anamnesis  being 
of  high  importance  in  a  case  of  this  kind,  it  may  be  added  that 
the  patient's  father  had  always  been  in  good  health.  The  oldest 
son  of  his  brother,  however,  had  been  a  lunatic,  a  second  son 
had  died  in  an  insane  asylum,  a  son  of  this  latter  being  affected 
with  a  brain  trouble  at  the  present  time;  the  son  of  another 
brother  was  in  an  asylum  because  of  paralysis;  the  patient's 
mother  and  her  mother's  two  brothers  and  a  sister  are  suffering 
from  Tic  convulsif.  Patient  has  two  brothers,  both  likewise  ab- 
normal, and  a  sister  who  presents  the  second  case,  upon  which 
we  shall  here  dwell  for  the  sake  of  a  more  thorough  under- 
standing. 

Miss  M.  N.,  thirty-six  years  of  age,  states  she  has  never  been 
normal  since  her  earliest  youth;  was  tortured  by  most  baneful 
doubts,  especially  on  religious  subjects,  even  when  a  child.  "  I 
dare  say,  doubt  and  anxious  scrupulosity  were  growing  apace 
with  myself."  She  remembers  of  having  been  in  constant  doubt, 
even  at  the  early  age  of  ten,  whether  or  not  that  what  she  had 
thought  or  said  had  not  been  in  the  nature  of  a  sin.  Frightened 
by  the  doubts  which  she  never  could  banish,  she  wrote  her 
thoughts  down  upon  slips  of  paper,  which  she  conveyed  to  her 
mother,  with  the  request,  to  ascertain  whether  or  not  these 
thoughts  contained  anything  sinful,  her  sister  acting  as  go- 
between.  Her  doubts  were  mostly  on  religious  topics.  "Often 
I  was  harassed  by  this  question':  If  I  had  the  alternative  to  com- 
mit a  sin  or  to  go  to  prison,  which  would  I  choose?  Thereupon 
if  I  would  decide,  for  the  sake  of  life,  for  the  former,  then  the 
idea  would  at  once  strike  me:  Thou  hast  mentally  committed  a 
grave  sin.  This  made  me  excited.  I  wrung  my  hands  and  cried 
out  loud,  No,  no,  I  dare  not  do  it,  nor  will  I  do  it.  At  church  I 
am  afraid  of  not  being  attentive  enough— thinking  of  having  pur- 
posely taken  my  eyes  off  the  priest,  and  looked  upon  other  people 
in  order  to  disturb  them  in  their  worship,  and  thus  give  public 
offense  in  the  church."  When  occupied  with  the  most  simple 
and  ordinary  work  of  every-day  life,  patient  is  in  doubt  whether 
or  not  she  has  done  something  sinful  or  whether  or  not  she 
should  cease  to  do  certain  work  for  the  sake  of  religion.  "  Now, 
when  this  doubt  on  certain  days  is  growing  exuberantly,  then  I 


PASTORAL    MEDIC/ME. 


CLINICAL  CASES.  301 

cry  out,  No!  No!  I  am  not  afraid,  I  don't  want  to  be  afraid! 
When  copying,  or  when  paying  a  bill,  she  was  constantly  in 
doubt.  "  My  hardest  task  is  to  pass  over  a  threshold— I  always 
think  to  commit  a  sin  thereby.  I  often  remain  standing  in  front 
of  it,  as  if  under  a  spell.  I  exert  myself  to  step  across  (fast 
moving  her  lips,  talking  to  herself)  ;  finally  I  step  across,  although 
in  greatest  excitement  and  anxiety.  Many  times  I  can  only  do 
it  if  one  of  my  folks  takes  my  hand  and  draws  me  across." 

She  anxiously  avoids  to  put  her  foot  upon  the  joints  of  the 
floor;  there  might  be  evil  thoughts  therein.  Her  fear  of  fire  is 
indescribable.  After  putting  out  the  lamp  in  her  room  at  night, 
she  must  make  sure,  time  and  again,  whether  the  light  has  been 
extinguished.  She  is  ever  in  fear  of  becoming  asphyxiated 
through  her  own  carelessness,  although  she  fails  to  see  any- 
thing burning  or  glowing.  In  church  she  is  struck  by  the  sudden 
idea,  not  to  have  behaved  decently;  of  having  seduced  others  by 
a  glance  or  certain  motions,  to  disbelieve  God's  Word  that  just 
has  been  preached  from  the  pulpit.  Everywhere  in  her  life  she 
is  confronted  by  scruples,  dangers,  fears  and  obstacles.  "  How 
happy,  on  the  contrary,  are  other  people !  How  must  I  be  afraid 
to  be  thought  crazy !  Why  is  it  that  just  I  am  incapable  to  quiet 
myself,  to  think  and  feel  like  other  people?  The  paroxysms 
last  from  one  to  twelve  hours  and  are  preceded  by  an  aching  of 
all  nerves.  Remissions  are  most  pronounced  when  she  travels, 
or,  at  times,  when  she  is  much  occupied  or  when  attending 
parties.  Invariably  she  never  feels  better  than  on  the  first  day 
of  menstruation.  Patient  is  intelligent  and  educated.  No  indi- 
cations of  masturbating  (neither  in  her  sister).  She  sleeps  well 
but  has  little  appetite.  Iron  bromide  of  potassium  4.0,  and  cold 
rubbings  brought  relief.  In  winter,  however,  nutrition  decreases, 
the  sanguification  deteriorates,  whereupon  nervous  troubles  and 
compulsory  notions  recur  again.  M.  N.  does  not  possess  a  system- 
building  "mania";  her  morbid  thoughts  have  not  altered  her 
relations  to  her  family  and  society;  she  is  a  judicious  person, 
capable  of  plying  her  vocation  and  to  be  conscious  of  the  mor- 
bidity of  her  compulsory  thoughts.  Hence  we  have  all  the 
significant  tokens  combined  of  the  ailment  called  compulsory 
notion.  Patient,  conscious  of  her  morbid  ideas,  endeavors  to 
struggle  against  them  with  all  her  powers;  she  is  her  own  e 
cellent  observer  and  draws  a  minute  and  precise  picture  of  her 
mental  agony,  as  most  of  these  unfortunates  do. 


302  PASTORAL    MEDICINE. 

From  this  general  depiction  of  compulsory  notions,  and 
resulting  compulsory  conditions,  it  becomes  clear  that  it  is 
irrelevant  in  what  shape  these  thoughts  appear,  what 
course  they  take ;  whether  the  patient  must  constantly  ask 
himself :  why  does  the  earth  revolve  ?  or  whether  he  must 
picture  to  himself  a  fact,  e.  g.,  the  unexpected  death  of  a 
child,  or  a  man  who  hung  himself  by  the  neck  and  of 
whom  he  was  told,  or  an  obscene  process ;  or  whether  the 
notion  is  followed  by  the  corresponding  act,  like  the  pa- 
tient who  had  to  read  from  right  to  left  all  the  signs  he 
saw,  or  like  the  woman  who  had  to  pronounce  a  certain 
number  before  she  could  do  even  the  most  trifling  thing. 
In  every  case  the  brain  labors  under  a  compulsion. 

If  the  subject  of  the  notion  is  indifferent,  then  the 
notion  is  apt  to  be  considered  simple  foolishness  of  no 
account,  simply  a  silly  play  of  imagination,  but  if  the 
notions  are  of  a  moral  or  religious  nature,  then  they  are 
often  ascribed  to  satanic  influences,  thought  to  threaten 
the  religious,  moral  life  in  a  peculiar  way.  The  true 
nature,  however,  becomes  revealed  by  analyzing  these  sur- 
prising and  compulsory  processes  and  by  a  conscientious 
anamnesis  so  far  as  the  latter  be  possible.  Then  the  soil 
whereupon  these  mental  maladies  are  growing  is  dis- 
covered. 

We  shall  not  investigate  in  how  far  the  devil,  the  fiend 
of  any  peace  of  soul,  uses  the  morbidly  discordant  nerves 
as  a  basis  for  his  operations,  we  shall  on  the  contrary  con- 
tent ourselves  in  the  interest  of  the  patient  to  attribute 
these  conditions  to  the  morbid  state  of  the  nerves.  Every 
priest  must  admit  that  he  has  not  solely  to  deal  with  nor- 
mal minds;  he  often  meets  minds  wherein  the  disease  is 
either  developing,  or  progressing,  though  they  appear  out- 
wardly to  be  whole,  and  the  number  of  these  "sick  souls" 
is  not  small.  It  does  make  a  difference  whether  the  priest 


COMPULSORY  NOTION  vs.  TEMPTATION. 303 

has  an  insight  into  such  morbid  conditions  or  whether  he 
mistakes  them  for  temptations.  The  afflicted,  to  be  sure, 
takes  them  in  most  cases  to  be  the  product  of  his  wicked 
mind. 

We  do  not  maintain  that  temptations  and  enticements 
do  not  happen  to  entirely  healthy  persons,  without  any 
help  of  morbid  influences,  but  it  must  be  taken  for  granted 
that  the  conditions  described  here  are  caused  by  disease 
and  hence  need  a  different  treatment.  A  parallel  between 
compulsory  notion  and  temptation  will  show  us  the  dif- 
ference between  whole  and  sick  souls.  The  parallel  will 
in  itself  solve  the  question  as  to  the  responsibility,  because 
the  psychiatric  theory  of  compulsory  notions  and  condi- 
tions does  not  remove  the  moral  responsibility  which,  how- 
ever, in  kindred  cases  can  never  wholly  be  determined. 
The  responsibility  will  only  be  distributed  and  valued  dif- 
ferently. The  whole  and  the  sick  have  different  thoughts. 

VIII.     DIFFERENCE    BETWEEN    COMPULSORY 
NOTION  AND  TEMPTATION. 

We  are  conscious  of  exceeding,  in  the  following  discus- 
sions, the  scope  of  this  work.  Nevertheless  our  chapter 
would  lose  much  of  its  usefulness  should  we  omit  to  take 
up  this  part  of  our  subject. 

First  of  all  the  question :  What  is  understood  by  temp- 
tation ? 

As  a  rule,  by  temptation  is  understood  any  incite- 
ment to  evil  from  within  or  from  without  "conatus  volun- 
tatem  pertrahendi  ad  peccatum."  They  are  thoughts, 
ideas,  sensations,  appetencies,  and  inclinations,  incited 
either  from  within,  by  our  own  nature,  or  from  without, 
by  the  world  and  by  the  fiends  that  are  urging  us  on  and 
enticing  us  in  order  to  appease  our  inclination  to  violate 
the  law  divine,  and  to  subordinate  the  most  holy  will  of 


3o4  PASTORAL    MEDICINE. 

God  to  our  own  disorderly  volition.  In  general,  to  tempt 
means  to  try,  to  put  to  trial,  to  test. 

According  to  this  definition  temptation  is  in  essen- 
tial relation  to  the  moral  law  prescribed  by  the  Lord  and 
by  nature ;  hence  temptation  is  the  source  of  either  guilt 
or  merit,  according  as  to  whether  the  tempted,  a  perfectly 
free  agent  and  possessed  of  full  knowledge,  decides  for 
or  against  the  temptation. 

Any  temptation  is,  therefore,  primarily  an  interior  pro- 
cess. It  may  appear  in  its  tamest  form  as  motus  primo 
primi,  qui  non  solum  in  appetitu  sensitivo,  sed  etiam  in 
voluntate  (c.  gr.  motus  odii,  superbiae,  contra  fidem,  etc.) 
oriunter  et  in  malum  tendunt,  or  it  may  be  caused  from 
without  by  an  opportunity  or  impetus.  It  moves  in  the 
moral  sphere  exclusively.  The  decision  for  or  against,  in 
asserting  or  declining,  in  committing  or  omitting,  brings 
about  its  termination.  In  comparing  our  conception  of 
temptation,  as  far  as  it  relates  to  a  process  from  within,  to 
our  conception  of  compulsory  notion  we  find  a  surprising 
and  deceiving  similarity  in  the  manner  of  appearance  in 
their  subjects  and  in  their  shape.  This  similarity  is  es- 
pecially deceiving,  when  the  compulsory  notions  trans- 
gress from  an  indifferent  into  a  moral  and  religious 
sphere,  being  possibly  in  the  nature  of  contrasting  no- 
tions. Considering  the  perturbating  influence  of  these 
thoughts  upon  mind  and  soul,  it  is  no  wonder  that  many 
a  person  believes  the  veritable  devil  to  be  at  the  bottom 
of  them.  Now  for  the  differential  diagnosis : — 

Compulsory  notion  is  likewise  a  process  from  within,  it 
appears  just  as  spontaneously  as  the  temptation,  its  asso- 
ciation can  not  be  traced,  to  wit,  it  does  not  reveal  itself 
to  consciousness.  However,  it  maintains  itself  perma- 
nently without  being  caused  by  any  affection,  which  is 
never  the  case  with  temptations.  Further,  the  compul- 


COMPULSORY  NOTION  vs.  TEMPTATION. 303 

sory  notion,  by  its  pathological  intensity  and  endurance, 
and  in  respect  to  the  actions  resulting  from  it,  may  as- 
sume the  psychological  significance  and  the  compelling 
power  of  real  insanity,  which  is  altogether  impossible  in 
the  case  of  temptation.  The  latter  touches  only  upon  the 
ethical  part  of  man,  compulsory  notion  may  move  along 
in  different  roads.  Should  it  likewise  touch  upon  the 
ethical  part  of  a  person  or  upon  his  religious  sentiment, 
then  it  is  like  the  motus  primo  primi  in  the  moral  theo- 
logical sense,  only  the  mind  is  cognizant  of  it,  because  it 
is  morbid  and  inapprehensible  for  the  critic,  i.  e.,  no  judg- 
ment can  be  formed,  hence  it  is  beyond  the  control  of  the 
will  power.  Moreover,  the  compulsory  notion  in  its  sim- 
ple and  complex  form,  as  well  as  in  its  consolidation  into 
compulsory  condition,  is  unlike  temptation  because  the 
afflicted  in  the  resulting  omissions  and  commissions,  does 
not  look  for  a  gratification  of  his  desire.  On  the  con- 
trary it  is  in  the  nature  of  the  whole  process  that  its 
aim  fails  to  satisfy.  It  is  the  daily  work  of  the  ailing 
nerves  to  transform  everything  disagreeable,  any  trivial, 
miserable,  petty  thing  in  everyday  life,  into  a  torturing 
compulsory  notion,  so  that  an  ill-considered  word  may 
evoke  nearly  the  same  remorse  as  a  parricide  would.  The 
devilishness  of  it  all  is  that  the  nerves  do  only  molest  one 
with  the  disagreeable  things,  compelling  the  patient  to 
think  them  out  into  the  most  remote,  horrifying  conse- 
quences. 

A  characteristic  sign  of  the  compulsory  notion  is  their 
typical  subject,  especially  manifest  in  contrasting  notions 
(e.  g.  blasphemous).  The  author  has  seen  this  confirmed 
in  a  number  of  afflicted,  whose  blasphemous  thoughts,  es- 
pecially those  relating  to  the  Holy  Mother  were  of  a  per- 
fect congruity.  The  same  applies  also  to  notions  of  an  in- 
different subject.  Finally  the  morbid  character  of  com- 


306  PASTORAL    MEDICINE. 

pulsory  notions,  and  hence  its  contrariness  to  temptation, 
may  be  recognized  by  the  fact  that  these  thoughts  as  well 
as  the  accompanying  anxiety  and  fear  can  be  made  to 
vanish  by  an  operation  wholesome  to  the  nerves,  such  as 
cold  baths,  etc.  Even  a  thorough  cure  may  be,  and  has 
been,  effected  without  the  aid  of  religion  in  influencing 
the  mood.  Another  difference  is  this,  the  patient  may  be- 
come weak-minded  or  idiotic  when  receiving  awkward  treat- 
ment and  if  the  surrounding  conditions  are  unfavorable. 
In  contrasting  temptation  and  compulsory  notion  we  do 
not  attempt  to  draw  a  sharp  dividing  line,  the  principal 
task  being  in  such  cases  to  trace  the  particular  manifesta- 
tion of  a  person's  mental  life  from  his  general  condition 
and  thus  to  indirectly  find  the  right  diagnosis  by  means 
of  anamnesis. 

IX.  RESPONSIBILITY  OF  PERSONS  WITH  COMPUL- 
SORY NOTIONS  AND  IN  COMPULSORY  CONDITION. 

According  to  the  description  given  of  the  different 
forms  of  the  notions,  there  can  no  longer  be  a  doubt  as  to 
the  morbidity  of  the  condition.  It  is  a  morbid  state, 
for  the  reason  that  the  patients  are,  as  a  rule,  predis- 
posed for  their  condition  because  of  an  evident  psycho- 
neuropathical  constitution,  or  of  morbid  disturbances  of 
mood  and  of  sentiment.  Of  course  there  are  also 
physiologically  normally  constituted  people,  who,  never- 
theless, are  tortured  by  whimsical  and  hideous  notions 
entirely  foreign  to  their  ethical  consciousness.  Who 
does  not  know  that  a  person  when  standing  on  the  brink 
of  an  abyss  is  easily  struck  by  the  idea,  How  would 
it  be  to  leap  down?  although  that  person  is  free  of  any 
taedium  vitae.  Krafft-Ebing,  however,  maintains  that 
the  number  of  like  persons  is  insignificantly  small  if 
compared  to  the  number  of  cases  wherein  compulsory 


RESPONSIBILITY.  307 

notions  are  caused  by  the  neurasthenic  disposition  of  the 
person.  As  stated  before,  the  compulsory  notions  are  es- 
pecially grave  if  they  extend  their  perturbating  influence 
upon  the  religious  mood  and  the  conscience  of  the  patient. 
To  sum  up:  the  responsibility  for  compulsory  ideas 
and  the  actions  resulting  therefrom  must  only  and  solely 
be  judged  by  the  amount  of  free  agency,  of  which  the  pa- 
tient is  yet  possessed.  Krafft-Ebing  assumes  a  number 
of  vastly  different  degrees,  he  thinks  a  morally  strong 
mind  full  of  will  power  may  perhaps  emerge  victoriously 
from  the  struggle,  yet  there  are  also  stages  where  the  free 
agency  has  been  wrecked  by  psychical  compulsion.  This 
might  be  the  case  even  if  there  is  but  one  single  morbid 
notion,  as  the  observer  would  be  wrong  to  assume  a  per- 
son could  be  whole  with  even  only  one  single  notion. 
His  other  slight  disturbances  of  the  mind  are  often  not 
perceived  so  easily  and  readily.  Besides,  we  are  never  full 
masters  over  the  contents  of  our  consciousness,  nor  can 
we  efface  the  single  thoughts  at  will  from  our  conscious- 
ness, not  even  if  the  train  of  notions  has  run  its  course 
without  interruption.  This  explains  the  most  manifold 
combinations  incidental  to  such  morbid  states,  because 
in  connection  therewith  there  may  be  disturbances  in  an- 
other sphere,  that  of  the  will,  in  view  of  the  ultimate  mu- 
tual relation  between  thinking  and  feeling ;  in  the  extreme 
case  we  have  no  longer  to  deal  with  actions  by  will,  but 
with  actions  by  impetus,  wherein  reason  is  no  longer  the 
controlling  factor,  as  we  have  seen  in  the  cases  quoted. 
Hence,  if  e.  g.  a  person  at  Confession,  while  confessing  his 
sins,  suddenly  begins  to  curse  and  to  swear,  and  then  feels 
most  unhappy  because  he  could  not  help  it,  then  we  cannot 
hold  him  responsible,  because  he  is  obeying  a  morbid 
impetus,  the  accompanying  symptom  of  a  violent  nervous 
disease,  as  proven  by  anamnesis.  The  belief  that  every 


308  PASTORAL    MEDICINE. 

man  can  control  his  thoughts  and  his  actions  under  any 
circumstances  must  be  qualified  in  our  cases.  The  tenet 
that  man  is  absolutely  master  of  his  own  thoughts  has 
more  or  less  of  a  limitation.  People  are  queer  creatures, 
a  hot  room,  a  gloomy  day,  lack  of  exercise,  indigestion, 
often  form  the  whole  difference  between  happiness  and 
misery,  courage  and  energy. 

Leibnitz,  the  philosopher,  is  said  to  have  always  tested 
his  mood  before  sitting  down  to  a  difficult  mental  work. 
Who  has  not  yet  suffered  from  the  whims  and  the  irrita- 
bility of  persons  with  a  liver  complaint?  It's  a  matter 
of  common  knowledge  that  persons  whose  hearts  are  af- 
fected are  tortured  by  an  anxious,  scrupulous  conscience, 
while  on  the  other  hand  their  ire  is  aroused  by  a  mere 
trifle.  According  to  Hans  Jacob,  Schopenhauer  would 
never  have  proposed  as  axiom  his  assertion  of  the  identity 
of  body  and  will  had  he  had  knowledge  of  the  compul- 
sory notions.  It  is  commonly  conceded  that  poor  physi- 
cal condition  makes  a  doubter  out  of  man  and  excites  a 
lasting  discord  between  body  and  mind. 

If  the  will  is  often  powerless  against  sensual  affections, 
because  by  suddenly  arising  they  arrive  sooner  than  the 
act  of  the  will,  this  is  even  more  the  case  with  compul- 
sory notion,  when  the  most  earnest  struggle  to  escape  the 
pangs  of  the  imaginary  play  are  in  vain.  Many  a  person 
would  will  if  he  only  could. 

To  arrive  at  a  practical,  suitable  judgment,  valuation 
and  treatment,  it  is  necessary  to  acknowledge  the  morbid- 
ity of  this  real  alienation  of  mental  life,  which  stands  off 
from  a  healthy  mental  life.  As  shown  by  the  examples  it 
is  clear  that  a  person,  whose  mental  life  has  taken  a 
change,  may  have  become  ailing,  may  have  become  psy- 
chopathetical,  without  being  of  a  diseased  mind  in  the 
real  sense. 


FURTHER  DEVELOPMENT.  309 

It  is  certain  that  this  special  kind  of  morbid  formal  dis- 
turbances of  the  thinking  power  is  always  developed  from 
a  neuropathic  case  and  cannot  grow  in  the  realm  of 
health.  Sometimes  the  patients  resemble  in  their  de- 
meanor some  stages  of  insanity,  but  they  lack  the  charac- 
teristic productive  delusion  supported  by  a  previous  ex- 
isting weakness  of  the  critic  powers,  which  are  a  mark  of 
all  typical  cases  of  paranoia.  In  most  cases  of  paranoia  the 
patient,  even  at  the  most  advanced  stages,  is  not  aware  of 
the  morbidity  of  his  delusions,  whereas  the  patient  afflicted 
with  compulsory  ideas  knows  perfectly  well  his  mor- 
bid condition  and  he  recognizes  how  inappropriate  and 
silly  his  thoughts  are.  In  how  far  the  developing  com- 
pulsory notions  infect  the  general  psychical  personality  of 
the  patient  depends  first  on  the  malady  itself,  partly 
also  on  the  surrounding  circumstances.  Not  a  few  per- 
sons afflicted  with  these  conditions,  especially  the  onerated 
of  a  robust  constitution,  continue  in  their  responsible  vo- 
cation, in  their  family  and  social  life,  notwithstanding  the 
fact  that  they  are  handicapped  by  their  notions.  The  term 
compulsory  notion  does  not  include  delusion,  except  sec- 
ondarily when  the  patient  who  feels  that  he  is  no  longer 
the  master  of  his  own  thoughts  should  interpret  this  to  be 
due  to  a  strange  personality  that  is  causing  these  thoughts. 
The  essential  difference  between  delusion  and  compulsory 
notion  is  therefore  this,  the  one  afflicted  with  notions  is 
aware  of  his  misery,  not  so  the  real  insane.  People  with 
a  nervous  ailing,  and  they  are  the  ones  mostly  afflicted 
with  compulsory  notions,  suffer  more,  by  the  continuance 
of  their  consciousness,  than,  for  instance,  melancholies. 

X.    FURTHER  DEVELOPMENT  OF  COMPULSORY 
CONDITIONS. 

The  question  which  causes  most  anxiety  to  such  pa- 


3  to  PASTORAL    MEDICINE. 

tients  who,  overcoming  their  shyness,  have  consulted 
an  expert,  is :  Is  it  possible  for  these  compulsory  notions 
and  conditions,  while  they  are  not  mental  diseases,  to 
develop  into  such?  In  general  this  is  not  the  case,  as  it 
can  be  proven  that  in  cases  of  insanity  the  compulsory 
thinking  as  such  has  not  changed  into  psychosis,  but  that 
the  insanity  is  due  to  another  cause,  and  that  it  is  immate- 
rial whether  or  not  the  patient  has  previously  been  afflicted 
with  compulsory  notions,  also  immaterial  whether  or  not 
such  notions  continue  after  insanity  has  set  in.  A  special- 
ist for  nervous  diseases  quotes  a  case  where  the  malady 
had  continued  for  thirty-eight  years  and  remained  until 
death,  without  developing  dementia.  In  view  of  the  fact 
that  anxiety  is  mostly  the  dominating  notion,  Dr.  Wille 
comes  to  the  conclusion  that  the  notions  develop 
into  melancholia,  especially  those  sets  of  notions  that 
do  not  deal  with  a  nonsensical  absurd  subject,  but  with  one 
that  is  simply  false,  untrue  and  contrary  to  real  condi- 
tion. Dr.  Wille  supports  his  view  by  citing  the  mania 
of  self-accusation  of  sinning.  We  can  only  concur 
therein  from  our  priestly  experience,  and  every  confessor 
will  easily  know  what  value  to  put  upon  those  endless, 
minute  and  detailed,  self-accusations,  if  he  duly  has  recog- 
nized the  fundamental  cause  for  this  self -torturing, 
anxious,  examination  of  conscience. 

The  danger  of  falling  into  a  certain,  though  not  deep, 
melancholia,  is  likely  to  exist,  as  there  are  "flowing  transi- 
tions" between  both  maladies  and  because  the  first  state 
may  at  any  moment  be  complicated  by  the  addition  of 
melancholia.  The  possibility  of  a  development  into  par- 
anoia, into  insanity  has  been  affirmed  by  Krafft-Ebing, 
Maynert,  Wille,  Schu'le  and  Kraepelin.  However,  such 
cases  are  said  to  be  very  rare.  The  development  has  been 
called  abortive  insanity.  On  the  other  hand  it  is  main- 


FURTHER  DEVELOPMENT.  3 1 1 

tained  by  Dr.  Koch,  that  the  compulsory  thinking  never 
produces  a  psychological  reaction  of  the  mood.  On 
the  contrary  he  thinks  that  these  conditions  are  rather  a 
safeguard  against,  than  favorable  for,  the  setting  in  of 
insanity. 

Dr.  Koch  points  to  the  fact  that  those  afflicted  with  no- 
tions keep  up  a  daily  struggle,  full  of  cares  and  anxieties 
for  years  and  years,  they  ply  their  vocation,  they  suc- 
ceed in  not  betraying  their  real  state;  compelled  to 
satisfy  their  notions  they  labor  often  in  addition  thereto 
under  the  fear  of  becoming  insane ;  yet  none  of  these  and 
similar  things  lead  to  a  breaking  out  of  insanity,  which 
ordinarily  is  favored  by  such  lasting  cares  and  griev- 
ances. However,  in  spite  of  Dr.  Koch's  quieting  declara- 
tion, the  old  tenet,  that  every  one  is  to  be  considered  men- 
tally sound  until  the  contrary  is  proven,  should  be  dis- 
carded and  the  view,  founded  upon  experience,  should  be 
adopted  in  its  stead,  that  there  exist  a  large  number  of  in- 
termediary links  of  morbid  symptoms  and  conditions. 

Between  people  in  perfect  health  and  wholly  sick  peo- 
ple there  are  a  great  number  of  persons,  in  whom  the 
whole  and  the  sick  is  mixed  and  where  only  some  single 
morbid  traits  are  manifest.  These  elementary  anomalies 
may  have  existed  at  the  birth  of  the  patient,  for  it  is  just 
in  our  cases  where  the  hereditary  psychopathical  constitu- 
tion plays  a  baneful  part.  The  temptation  lies  near  to 
show  at  this  juncture  that  the  compulsory  notions  may  be 
traced  back  to  puberty  and  even  further;  one  may 
rightfully  speak  of  some  such  morbid  conditions  not  only 
at  early  childhood,  but  one  may  speak  of  infantile  insan- 
ity. 

According  to  Drs.  Wille  and  Westphal  the  compulsory 
notions  do  not  favor  a  certain  sex.  Griesinger  says  they 
are  more  prevalent  among  men,  Schiile  and  Legrand  du 


PASTORAL    MEDICINE. 

Saulle,  however,  hold  they  are  more  prevalent  among  wo- 
men. No  line  of  demarcation  as  to  the  age  can  be  drawn  ; 
it  seems  that  middle  aged  persons  are  mostly  afflicted ; 
this  is  the  age  when  neurosis  and  psychosis  mostly  pre- 
vail. Dr.  Wille  observed  seventeen  patients  as  to  their 
ages:  between  fourteen  and  twenty  years,  two  men  and 
two  women;  twenty-one  to  twenty-five  years,  one  man, 
one  woman;  twenty-six  to  thirty  years  seven  men,  two 
women ;  thirty-one  to  thirty-five  years,  two  women ;  thirty- 
six  to  forty  years,  two  men,  two  women.  According  to 
my  experience  even  men  and  women  over  seventy  years 
are  subject  to  compulsory  notions.  Better  situated  classes 
are  as  a  rule  more  disposed  to  these  notions,  although 
nowadays  there  are  nervous  peasants,  peasant  women  and 
servant  girls,  who  may  individually  present  some  symp- 
toms of  predisposition. 

It  is  not  rare  to  find  a  coincidence  of  compulsory  no- 
tions with  a  shy  and  melancholy  nature,  with  weakness 
of  intellect,  with  a  painstaking  sense  for  order  and  clean- 
liness, with  an  inkling  of  -hypochondria  and  with  an  ex- 
acerbating of  neurasthenical  symptoms.  Griesinger  denies 
that  frequent  pollutions  are  one  of  the  causes;  Krafft- 
Ebing,  on  the  other  hand,  declares  that  these  notions  have 
been  observed  in  persons  predisposed  by  their  constitu- 
tion for  neurasthenia  who  have  brought  about  neurosis 
by  masturbating.  Further  etiological  and  occasional  mo- 
ments are  the  weakening  influence  of  childbed  upon 
women,  difficult  delivery,  large  loss  of  blood  and  anaemia, 
gravidity,  lactation ;  with  men,  alteration  of  the  mood, 
overexertion,  acute  diseases,  sexual  rioting,  fright,  anger, 
trouble,  chronic  dyspepsia. 

The  further  course  of  these  morbid  conditions  is  re- 
mitting; long  intermissions  are  by  no  means  rare;  it 
frequently  occurs  that  some  compulsory  idea  may  always 


TREATMENT.  313 

come  back  occasionally.  All  these  conditions  bear  a  cer- 
tain periodical  character,  hence  they  differ  very  much  in 
their  course.  Riots  in  baccho  et  venere  may  aggravate 
matters.  Whether  or  not  a  complete  cure  may  be  hoped 
for  is  difficult  to  establish  because  the  cases,  even  when 
acute,  are  rarely  healed  in  asylums,  hence  an  observa- 
tion of  the  extreme  development  is  rendered  impossible, 
because  the  private  cases  of  an  unfavorable  termination 
remain  unobserved.  As  far  as  they  have  been  studied 
periodical  melancholia  has  been  observed.  So  Krafft- 
Ebing  says.  This  malady  results  either  in  cure  or  in  a  state 
of  mental  torpor.  In  cases  where  the  malady  was  ac- 
quired, where  the  patient  had  not  been  naturally  predis- 
posed, a  cure  has  been  repeatedly  effected,  but  never  in 
other  cases,  although  an  intermission  lasting  for  years  has 
been  accomplished.  While  the  crisis  lasts  there  have  been 
observed  in  many  instances  taedium  vitae,  attempts  at 
suicide,  and  suicide.  In  the  later  case  the  chief  reason 
for  it  is  probably  pronounced  melancholia. 

XL     TREATMENT  OF  COMPULSORY  CONDITIONS. 

The  tracing  back  of  these  elementary  psychical  distur- 
bances to  a  neurothic  basis,  points  of  itself  to  the  door 
of  the  physician.  The  priest  who  is  to  give  advice  in  like 
cases  does  a  meritorious  act  by  explaining  the  morbidity 
of  the  condition  and  by  advising  to  consult  a  physician. 
As  to  the  treatment  of  the  cases,  theory  and  practice  in- 
dicate the  use  of  tonics  and  teach  the  value  of  fresh  air. 
According  to  the  patient's  individuality  the  climate  of 
the  sea  shore  or  of  the  mountains  is  to  be  chosen. 
In  connection  therewith  a  hydropathic  treatment  is  of 
great  advantage  (ablutions,  rubbing  down,  sponge  bath, 
bathing  in  ocean  or  river)  also  a  general  electrization 
(electric  massage,  electric  bath).  Of  medicines,  success 


3i4  PASTORAL    MEDICINE. 

may  be  expected  from  quinine,  ergotin,  zinc,  arsenic, 
phosphates,  opiates.  In  the  case  of  anaemia,  iron  should 
be  prescribed.  In  less  pronounced,  hysterical  cases 
Krafft-Ebing  has  successfully  prescribed  preparations  of 
zinc  (zinc  valerian,  zinc  bromat.).  In  cases  of  pronounced 
psychical  hyperaesthesia,  with  notions  of  a  homicidal  or 
suicidal  character,  he  has  successfully  made  use  of 
preparation  of  zinc  with  opium.  The  nourishment  should 
contain  much  albumen  and  fat.  Insomnia,  if  based  on 
pronounced  anaemia,  should  be  treated  with  alcoholic  bev- 
erages, especially  beer ;  otherwise,  according  to  special  in- 
dication with  bromo  preparations  (4-5.  o)  opio  quinine, 
paraldehyd. 

A  priest  who  has  gained  an  insight  into  the  conditions 
spoken  of,  will  understand  first  of  all  that  many  of  these 
careworn  people  are  subjects  for  medical  treatment.  He 
recognizes  the  soul-ache  to  be  the  outcome  of  an  existing, 
if  hidden,  nervous  ailment ;  he  can  realize  the  agony  suf- 
fered by  these  poor  creatures ;  he  knows  how  burdensome 
their  lives  are.  Hence  he  will  advise  to  consult  a  physi- 
cian, not  any  physician,  but  an  experienced,  conscientious 
specialist.  Dr.  Koch  does  not  hesitate  to  maintain  that  a 
physician  if  not  thoroughly  versed  in  the  treatment  of 
nervous  diseases  is  apt  to  commit  bigger  blunders  than 
the  layman,  for  no  other  reason  than  because  he  lacks  the 
faculty  of  analyzing  critically  and  thoroughly  the  tangle 
of  ideas  and  emotions  especially  of  the  scrupulous  reli- 
gious. Unprincipled  would  be  the  advice  to  banish  com- 
pulsory ideas  on  sexual  subjects  by  indulging  in  sexual 
relations,  especially  outside  of  wedlock,  with  all  its  dan- 
gers for  body  and  soul.  Even  matrimony  does  not  offer 
any  cure  for  these  conditions,  except  in  those  cases  where 
there  is  a  lack  of  regularity  in  living  and  of  a  moral  aim. 
Krafft-Ebing  says:  It  bespeaks  sadly  for  the  defective 


THE  TASK  OF  THE  PRIEST.  315 

hygienic  education  of  the  present  time,  when  even  physi- 
cians look  forward  to  matrimony  as  a  curative  for  ner- 
vous diseases,  e.  g.  hysteria,  and  when  they  even  suggest 
such  a  step  to  their  clients.  The  author  has  known 
many  men  and  women  subject  to  compulsory  notions  al- 
though they  had  been  married  for  many  years.  Statistics 
show  that  among  a  large  part  of  hysterical  persons  75 
per  cent,  had  had  children  and  65  per  cent,  had  had 
more  than  three  children.  The  same  proportion  may  be 
rightfully  assumed  to  apply  to  the  conditions  treated 
herein. 

XII.    THE  TASK  OF  THE  PRIEST. 

Somatical  treatment  must,  however,  go  hand  in  hand 
with  psychical  treatment  and  there  lies  for  the  priest  a 
large  and  fertile  field,  though  beset  with  difficulties.  In 
this  case  the  appellation  "physician  of  souls"  will  not 
signify  an  empty  title  for  him,  for  it  takes  any  amount  of 
sympathy  and  patience  to  listen  with  interest  to  the  ever- 
recurring  accusations. 

i.  First  of  all  the  priest  will  have  to  enlighten  the 
complainant.  Often  the  sting  of  the  agony  is  removed 
as  soon  as  the  patient  has  learned  of  the  true  nature  of 
his  malady  and  has  been  quieted  by  the  assurance  that 
these  tormenting  conditions  have  a  pathological  basis; 
the  priest  will  reassure  the  patient,  that  he  is  in  no  dan- 
ger from  insanity,  albeit  he  at  times  is  subject  to  a 
strange  anxiety ;  he  will  reassure  him  that  it  was  not  his 
depraved  heart,  that  has  evoked  his  blasphemous  thoughts 
while  at  worship,  but  that  they  were  due  to  a  slight  illness, 
a  momentary  fatigue  from  overwork  or  to  any  other  in- 
different cause.  He  will  tell  him,  that  there  is  no  occa- 
sion for  compunction,  but  that  he  ought  to  take  some 
exercise,  to  join  pleasant  company,  to  seek  distraction.  An 


316  PASTORAL    MEDICINE. 

enlightenment,  to  good  purpose,  will  not  burden  the  soul 
but  unburden  it. 

2.  It  being  a  matter  of  experience  that  the  onerated 
are  already  afflicted  in  their  youth  with  compulsory  notions 
and  conditions,  it  is  the  duty  of  those  conducting  the  edu- 
cation, especially   in   institutions,  to  investigate  calmly, 
kindly,   gently   and   with   perseverance,   why   there   are 
sometimes  obstacles  to  an  educational  success.     Many  a 
time  it  will  then  become  evident  that  the  manifest  inap- 
petency  for  work,  the  reduced  capability,  the  mental  palsy, 
plain  to  all,  the  striking  absence  of  mind,  the  inattention 
and  apathy  at  school,  bashful  and  reserved  ways,  that 
slight  inclination  to  gloominess,   that  wavering  of  the 
whole  demeanor,  that  all  these  are  not  character-traits, 

.but  a  consequence  of  the  conflict,  the  defensive  struggle, 
which  the  poor  tortured  has  to  wage  with  the  torturing 
process  within,  with  the  compulsory  ideas.  In  dealing 
with  his  charges,  teacher,  educator  and  priest  must  com- 
bine the  love  of  the  friend,  the  earnestness  of  the  master 
and  the  invincible  patience  of  the  humanitarian  who  feels 
that  he  is  human  himself  and  that  he  has  to  deal  with  a 
human  being.  Warm  and  intelligent  sympathy,  suit- 
able enlightenment,  keeping  off  evil  influences,  advice 
how  to  strengthen  the  will  power,  will  bring  relief,  the 
tendency  for  morbid  conditions  will  be  restrained  or 
suppressed,  at  least  their  disastrous  course  mitigated  and 
their  damaging  effects  removed. 

3.  Imagination  is  a  powerful  vehicle  for  compulsory 
notions  as  we  have  seen.     It  can  become  a  blessing  for 
man  or  a  curse.    It  is  like  the  sacred  fire  of  Vesta,  glow- 
ing and  animating  while  watched,  but  destroying  when 
unfettered.     Hence  an  indulging  in  sentiments  and  fan- 
cies  must   not   be   nourished,   but   carefully    restrained, 
this  applies  to  young  and  old  alike.    Sanguinary  natures 


THE  TASK  OF  THE  PRIEST.  317 

must  be  held  by  salubrious  compulsion  to  regular  activity 
or  they  must  be  made  to  conform  severely  with  the  order 
of  the  day.  Serua  ordinem  et  ordo  te  servabit,  says  St. 
Augustine. 

4.  The    priest,    as    the    confessor,    will    urge    those 
afflicted  to  fully  reveal  themselves  to  him.    This  is  neces- 
sary because  there   exists   a  general   prejudice   against 
psychical   disturbances,   even  in  educated  circles;  as  a 
result,  the  patient,  owing  to  a  false  shame  and  shyness, 
is  loath  to  reveal  with  candor  what  is  in  his  heart.     It 
is  just  the  candor  or  sincerity  with  which  the  inner  misery 
is  revealed  to  a  friend,  a  kin,  a  husband  or  a  wife,  which 
furnishes  the  first  hold  for  beneficial  assistance.     This 
sincerity  merits  a  reward  in  the  shape  of  unlimited  pa- 
tience with  the  afflicted. 

5.  This  patience  must  therefore  be  exercised  by  always 
listening  attentively  to  his  woes.    The  compulsory  notions 
should  never  be  denounced  as  craziness  or  nonsense,  this, 
if  ever  so  well  meant,  would  only  effect  the  reverse  of  the 
intended  result.     However,  in  listening  patiently  to  the 
account  of  the  compulsory  notions,  the  priest  must  never 
exhibit  weakness  of  will  power  or  hesitancy.     It  would 
be  advisable  first  of  all,  that  the  confessor  consents  to  the 
penitent's  laying  bare  the  whole  condition  of  his  soul 
openly  and  thoroughly,  but  only  once.    Any  subsequent 
repetitions  and  rehearsings  of  his  story  should  be  cut  off 
earnestly  and  decidedly  by  the  short  remark,  "Yes,  I 
know  all  this  already,  let  us  talk  of  something  else" ;  thus 
leading  the  conversation  into  another  channel.    Any  hes- 
itancy would  be  out  of  place,  moreover  it  would  be  a 
grave  error  for  the  advising  priest,  to  view  with  alarm 
certain  striking  symptoms.     If  the  penitent  e.  g.  should 
curse  and  swear  most  awfully  during  confession  as  well  as 
at  the  beginning  and  finish,  then  the  confessor  should  out- 


3i8  PASTORAL    MEDICINE. 

wardly  preserve  a  calm  and  unaffected  demeanor  while  in- 
wardly taking  cognizance  of  the  malady.  He  knows  that  a 
psychopathical  person  kneels  in  front  of  him,  who  per- 
haps on  account  of  a  cold  has  not  had  her  menses,  and  that 
this  condition  has  produced  that  dismal  but  irresistible 
impetus.  One  imprudent  word  may  put  her  in  despair 
and  rouse  in  her  the  delusion  of  her  damnation,  for,  not 
knowing  the  true  cause  of  her  state,  she  will  attribute  her 
contrasting  notions  to  her  own  depravity.  No  confessor 
should  overlook  the  fact,  that,  the  more  violent  struggle 
and  defence  have  been,  the  more  blasphemous  become 
the  thoughts,  as  in  such  cases  there  always  have  been  such 
struggles. 

6.  Such   patients,    especially    if   their    religious    and 
moral  life  be  the  object  of  a  vehement  attack,  are  prone 
to  change  their  spiritual  advisers,  which  finds  explanation 
in  their  hunger  for  consolation.     Hence  they  should  be 
required,  like  all  overscrupulous,  to  remain  with  the  con- 
fessor once  chosen,  to  confide  in  him  and  to  obey  him. 
Else  the  confessor  should,  if  feasible,  communicate  with 
the  newly-chosen  confessor,  tell  him  all  about  the  case 
and  what  advice  he  has  given. 

7.  A  violent  struggle  against  these  compulsory  no- 
tions, energetic  attempts  to  suppress  them,  are  of  evil.    A 
good  advice  is  to  let  any  whimsical  idea,  a  doubt,  rest 
for  a  day,  so  to  speak.    As  a  rule  the  disagreeable  thought 
becomes  stale  after  a  day,  at  least  it  loses  its  vividness, 
or  it  vanishes  entirely.  If  possessed  of  the  notion  to  verify 
whether  this  or  that  is  done  properly,  let  the  patient  not 
immediately  follow  his  momentary  impetus  to  verify,  but 
fix  a  quite  distant  date  for  him  to  go  to  the  root  of  the  mat- 
ter. When  the  time  fixed  arrives,  the  doubt,  etc.,  has  lost 
its  strength  or  has  entirely  vanished  by  this  happy  self- 
deceit.     "The  more  the  nerves  of  these  patients  are  af- 


THE  TASK  OF  THE  PRIEST.  319 

fected,  the  more  prone  they  are  to  indulge  in  unsound 
religious  notions  and  exercises.  It  is  certain  that  many 
morbidly  egotistical  ideas  never  vanish  but  for  the  aid 
of  religion ;  it  is  certain  that  religion  only  is  often  able  to 
induce  a  patient  not  to  brood  over  his  ailment  and  thereby 
retard  an  improvement ;  it  is  certain  that  many  a  perverse 
and  evil  inclination  is  not  suppressed  by  indulgence,  but 
by  invoking  the  power  of  religion  against  it.  But  just 
as  certain  it  is  that  many  a  cure  has  been  retarded  by  im- 
proper religious  doings,  certainly  many  a  malady  is  su- 
premely ruled  by  morbid  religious  notions,  and  a 
person  may  occupy  herself  too  much  with  religious  mat- 
ters. Where  the  troubles  and  temptations  themselves 
are  morbid  or  intermixed  with  morbid  religious  elements, 
there  naturally  is  a  longing  for  false  religious  remedies 
and  the  upshot  is  despondence."  (Dr.  Koch.) 

And  why  is  this  so  ?  Because  the  desired  success  fails  to 
be  achieved,  as  is  regularly  the  case  when  such  patients 
are  reading  ascetic  books  about  temptations,  etc.  It  is 
just  as  impossible  to  remove  morbid  conditions  by  reading 
such  books  as  it  is  impossible  to  cure  an  insane  of  his 
mania  by  arguments.  The  most  convincing  words  of  con- 
solation found  in  these  books  must  fall  flat,  "because 
they  were  not  written  for  them."  Everything  that  is 
good  may  be  wrongly  applied,  especially  here,  because  the 
application  is  made  from  out  of  the  morbid  mood.  No 
wonder  if  we  hear  the  plaint :  Now  it's  worse  than  ever. 

8.  It  is  best,  first  to  restrict  all  religious  demands  that 
are  only  still  more  confusing  and  burdening,  and  there- 
upon to  lead  the  afflicted  into  a  childlike  confidence  in 
God,  telling  them  God  is  aware  their  will  is  good,  He  rules 
this  small  world  of  ours  and  He  guides  those  whose  will  is 
good  upon  roads  which  lead  to  righteousness.  The  peni- 
tent should  be  warned  against  all  damaging  influences.  All 


320  PASTORAL    MEDICINE. 

overwork  and  over-stimulation,  bodily  or  mentally,  are 
damaging.  It  would  be  outrageous  to  tire  those  unfortu- 
nates out,  and  to  burden  them  down  with  work.  Again 
it  would  be  damaging  to  use  means  which  while  they  may 
serve  for  building  up  a  Christian  character,  would  fail  to 
prove  beneficial  in  this  instance.  Should  the  compulsory 
notions  range  into  the  religious  sphere,  then  the  afflicted 
are  to  be  treated  like  melancholies;  they  should  not  be 
burdened  with  more  religious  exercises,  etc.,  but  should 
on  the  contrary  be  restricted  therein.  Are  the  com- 
pulsory notions  of  an  indifferent  nature,  then  a  prudent 
adducing  of  comforting  religious  truth  will  certainly 
serve  a  good  purpose,  will  divert  the  thought  and  have 
an  elevating  and  easing  tendency. 

Excessive  fasting  should  also  be  warned  against  because 
the  nerves  if  poorly  nourished  would  lose  still  more  of 
their  energy,  hence  it  should  be  seen  that  the  patients  be 
well  fed.  The  adage  modicus  cibi,  medicus  sibi,  is  of 
great  value  only  to  the  healthy. 

In  our  time  when  there  are  so  many  "sick  nerves,"  the 
priest,  too,  will  have  occasion  in  his  vocation  to  meet  more 
morbid  conditions  than  he  likes  to;  however,  after 
some  diagnosis  of  the  mental  processes  above  described,  he 
will  be  ready  to  judge  the  cases  aright  and  to  give  benefi- 
cial advice.  His  own  gain  will  be  twofold ;  he  no  longer 
will  take  his  fellowmen,  nor  judge  them  or  treat  them,  all 
after  one  pattern;  by  this  individual-psychology  he  will 
find  the  road  to  the  proper  intercourse  with  the  patient, 
and  thus  may  lead  many  a  soul  to  peace. 


INDEX  OF  IMPORTANT  SUBJECTS. 


PAGE 

Abdominal  Diseases 123 

Abortion    86,  236 

Abstaining  32 

Accidents  124 

Administration     of     Sacra- 
ment to  Those  Apparently 

Dead   223 

Agony 74 

Air    II,  24 

Air  as  a  Cause  of  Disease..  14 

Albumen   29,  31 

Alcohol,  Poison  for  Children  95 

Alcoholic  Beverages 42 

Alcoholism   43,  163 

Anima  rationalis 89,  237 

Anomalies  of  Appetite   140 

Antiseptics 16 

Anxiety,  Compulsory 282 

Apoplexy   I2t 

Apparent  Death 223 

Artificial  Abortion 86,  236 

Asiatic  Cholera no,  119 

Asphyxy 74,  76,  77 

Atavism    I21 

Bacteria 16,27,  37,  ">9 

Banting  Cure  32 

Baptism  of  the  Child  in  the 

Womb 93 

Baptism  of  the  Fetus  . .  .90,  265 

Baptism  of  Infants  93 

Baptizing  those  Apparently 

Dead  225 

Bathing 62 

& 


PACK 
Bending   of   the   Spine    (in 

School   Children)    64,67 

Birth  92 

Burial 74,  79 

Burial  Vaults 24 

Burying  Alive   77 

Carbohydrates  29,  31 

Carbonates 29 

Carbonic  Gas 154 

Care  of  the  Child 94 

Castration    252 

Celibacy   101 

Cemetery    26,  82 

Cesarean  Section  247,  256 

Cesarean   Section  upon  the 

Dying  Woman  262 

—  After      the      Woman's 

Death    260 

Child  at  School  Age  97 

Childbed  Fever  120 

Chlorides   29 

Cholera 38 

Cholera  Morbus 19 

Clear  Ova  264 

Climacteric  Stage  131 

Climate    17,  21 

Clothing    47,  60 

Coal  Dust  iSi 

Colored  Undergarments  Poi- 
sonous    62 

Compulsory  Conditions 

(Nervous)  286 

Compulsory  Notions  267 


322 


PASTORAL  MEDICINE. 


PAGE 

Contagion,  How  to  Protect 
School  Children  Against.  69 

Craniotomy   247 

Cremation 80,  81 

Criminal  Abortion   89 

Criminal      Possibilities      of 

Hypnosis    161 

Crowded  Rooms  18 

Damp  Walls 48 

Death  74,  223 

Decomposition  of  the  Buried 

Corpse 81 

Delusions    131,  266 

Diet  of  the  Sick  30 

Difference     between     Com- 
pulsory       Notion        and 

Temptation    303 

Diphtheria no,  118 

Diseases  due  to  Occupations  149 
Diseases  of  Cattle  Transfer- 
able to  the  Human  System  35 
Diseases  of  the  Respiratory 

Organs    ; 122 

Disinfection .^ 1 16 

Drinking  Water.. 23,  27,  28,  29 

Drunkenness  164 

Dwelling 47 

Ectopic  Gestation  264 

Electric  Light   50,  51,  72 

Emotional  Disturbances  ...274 

Epidemics 71,  114 

Epilepsy   141 

Extirpation  of  Ovary  252 

Erotic  Insanity 137 

Fasting  32 

Fever  Patients  30 

Fire  Damp 54 


PAGE 

Fireplace 53,  55 

First  Aid  to  the  Injured: 
See  Separate  Index. 

Food 28,  34 

Foundlings 95 

Freezing 20 

Fruit   41 

Fuel 53 

Gases 154 

Gout 43 

Grave    84 

Ground  Air 24 

Growths  in  the  Uterus  ....245 

Hallucinations  131 

Headache  64 

Healing  Power  of  Climate..  17 

Heart  Diseases  123 

Heat  Prostration  18 

Heating  52,  72 

Hemorrhages  92 

Homicidal  Notions 282 

Hospital  71 

Human  Soul  Present  in 

Fetus  89,  237 

Humidity  of  the  Air 21 

Hydrophobia  109,  1 14 

Hygiene  II 

Hygiene  for  Hot  Days  . . . .  19 

Hygiene  of  Schools 63 

Hygienic  Requirements  for 

Dwellings 47 

Hypnosis  155 

Hysteria  144 

Illuminating  Gas 24,  50,  51 

Illusions 132,  266 

Immunity    112 


INDEX. 


323 


PAGE 

Impedimentum  Consanguin- 


itatis 


99 


Infanticide 95 

Infection    

Infectious  Diseases 109 

Infirmary  

Insanity i^ 

Iron  Dust 

Kleptomania   139 

Lead  Colic 151 

Leaden  Pipes,  Cause  of  Poi- 
soning    27 

Lighting    50,  72 

Liquor 42 

Malaria   22,  23 

Man  in  Sickness 107 

Mania   134 

Mania  of  Doubting 283 

Manners  of  Death 74,  79 

Marshy  Soil   25 

Means  of  Contagion  in 

Measles no 

Meat  28,  30,  34 

Melancholy    132 

Mental  Diseases  124,  266 

Mentally  Weak  Children  ..  97 

Mercury     150 

Mesmerism    158 

Milk,  Carrier  of  Contagion.  38 
Miraculous  Cures  not  Pos- 
sible by  Hypnosis 162 

Moment  of  Death 223 

Monotonous  Bill  of  Fare  . .  30 

Moral  Depravity  14^ 

Morbidity  of  Imagination.  .135 

Morphinism 172 

Mortality  Among  Religious 
Orders    104 


PAGE 

Mortality  Among  Inebriates  165 
Myoma  345 

Nervous  Diseases 141,  266 

Neurasthenia 266 

Neurasthenia  Sexualis 280 

Neurasthenics   in   the   Con- 
fessional   315 

New  Buildings  not  to  be  Oc- 
cupied   until    Thoroughly 

Dry    48 

Nursing  the   Sick    33 

Nutrition 28,  32 

Obesity   3032 

Obstetric  Operations  .  .236,  259 

Origin  of  Man 87 

Oxygen     I3 

Ozone   13 

Paralysis  due  to  Insanity  ..138 

Paranoia    135 

Phosphates    29 

Phosphorus 150 

Playgrounds    65 

Pork  Measles  35 

Porro  Section 252 

Predisposition 112 

Premature  Birth 227,  259 

Preventive  Measures  115 

Privies  58,  65 

Procuratio  Abortus 88 

Puberty    131 

Pulse    27,  28 

Raving  Madness  135 

Religious  Insanity 137,  266 

Religious   Orders    104 

Responsibility     of     Neuras- 
thenics     306 

Russian  Baths  .  .  18 


324 


PASTORAL  MEDICINE. 


PAGE 

Safety  Devices 149 

Scarlet  Fever 38,  110 

School  Benches  66 

School  Diseases .64,  69 

Schoolhouse    64 

Schoolroom    65 

Scrofula   30 

Short-sightedness  in  School 

Children    66 

Sick  Nerves  266 

Sick-rooms    72 

Signs  of  Death 74,  77 

Smallpox   no,  113 

Social   Legislation    149 

Soil    23 

Somatic  Diseases 108 

Sources  of  Infection  no 

Still-Born  Children 228 

Stimulants  42 

Stone  Dust  153 

Stoves    53 

Stuttering    97 

Sudden  Death  233,  260 

Suffocation    79 

Suggestion    155 

Suicidal  Notions  282 

Sulphates    29 

Sunstroke    19 


PAGE 

Surgical  Operations  253 

Syphilis  89,  109 

Tapeworms   34 

Teeth    63 

Temperature  13 

Tobacco    45 

Transmutation    130 

Treatment       of       Neuras- 
thenics     313 

Trichinosis    35 

Tropical  Diseases  22 

Tuberculosis 30,  35,  no,  117 

Tuberculous  Cattle   35 

Turkish  Baths  18 

Typhoid   38 

Typhus   no 

Underground  Water 24 

Vaccination   112,  113 

Variety  of  Food 30 

Veneric  Diseases 109 

Ventilation 50,  56,  57,  72 

Water  Closets  in  Schools..  65 

Water   Supply   26 

Weather  17 

Wells   24,  26 

Witchcraft  .  126 


FIRST  AID  TO  THE  INJURED. 

PAGE 

Acids,  hydrochloric  poison- 
ing    197 

—  hydrocyanic   poisoning. .  .198 

—  muriatic  poisoning    197 

—  nitric  poisoning   197 

—  oxalic  poisoning  197 

—  poisoning  from  197 


PAGE 

Acetylene  poisoning  203 

Acids,  acetic  poisoning,  etc.  197 

—  aqua  fortis  poisoning 197 

—  arsenious  poisoning    . . .  .200 

—  carbolic  poisoning  197 

—  carbonic  poisoning    203 

—  glacial  acetic  poisoning.  .197 


INDEX. 


325 


PAGE 

Acid,  prussic  poisoning  . . .  198 

—  sulphuric  poisoning 197 

Aconite  liniment  poisoning.  198 
Alcohol  poisoning 199 

—  for  wounds  18^ 

Alcoholic   intoxication    21 1 

Alkalies,    ammonia    caustic 

poisoning     199 

liniment  poisoning  ..199 

liquid  poisoning 199 

—  lime  poisoning 199 

—  potash  poisoning 199 

—  soda  poisoning   199 

Almond  flavor  poisoning  . .  198 

Aniline  dyes  poisoning 205 

Antimonial  wine  poisoning.  199 
Antimony  poisoning   199 

—  chloride  of,  poisoning  . .  199 

—  tartarated,  poisoning  . . .  199 
Aperients  in  poisoning  ....  196 

—  castor  oil  as 196 

—  sulphate     of     magnesia 

as    

Apoplexy — 

Aqua  fortis  poisoning  ....  197 

—  tofana  poisoning 200 

Arnica  poisoning 204 

Aromatic  vinegar  poisoning.  197 
Arsenic,  white,  poisoning.  .200 
Artificial    respiration.  .178,  189 

Hall's  method  ...187,  189 

Howard's  method.  187,  188 

Sylvester's  method  ...  187 

Asphyxia      from      blocking 

larynx 

choking 

drowning  

hanging    

poisonous  gases 193 

strangulation 193 


196 

2IO 


193 

193 
191 
193 


PAGE 

Atropine  poisoning 200 

Bed,  for  accidents 220 

Bed-fracture,  essentials  of.  .221 

Bedstead  for  accidents 220 

Belladonna  poisoning   200 

Bites  by  mad  dogs 184 

snakes 183 

Bitter  almonds  poisoning  ..198 

Bleeding  from  the  nose 180 

Blister  beetle  poisoning 201 

—  fluid  poisoning 201 

Blood,  spitting 179 

Blue  rocket  poisoning  198 

—  stone  poisoning  202 

—  vitriol  poisoning 202 

Breathing,  to  restore  from 

drowning  I91 

Burning  clothing,  to  extin- 
guish flames  of 216 

Burns  and  scalds 215,  222 

—  from  acids   216 

alkalies 216 

Camphene  poisoning  207 

Camphor  essence  poisoning. 201 

—  liniment  poisoning.  .I99»  201 

—  spirit  poisoning  201 

Cantharides  poisoning 201 

Carbolic  acid  poisoning 197 

Carbonic   acid   gas   poison- 
ing     203 

—  oxide  gas  poisoning 203 

Carrying  and  lifting  patients.22i 

—  of  injured 219 

Caustic,  lunar,  poisoning  .  .201 

Chalks,  poisonous  200,  204 

Charcoal  fumes,  poisonous.  .203 
Chloral   hydrate  poisoning. 201 

—  syrup  poisoning 201 


326 


PASTORAL   MEDICINE. 


PAGE 

Chloride  of  lime  poisoning.  .201 

—  of  zinc  poisoning 207 

Chlorine  gas  poisoning 201 

Chlorodyne  poisoning 206 

Chloroform  inhaled,  poison- 
ing   202 

—  swallowed,  poisoning    .  .202 

Choke  damp  poisoning 203 

Choking  from  accident 193 

Clothes,  removal  of,  in  acci- 
dents    221 

Clothing,  burning,  to  extin- 

.    guish  flames  of 216 

Codeine  poisoning  206 

Collapse  209 

Common  salt  for  wounds  . .  182 
Compound  fracture,  immedi- 
ate treatment  of 187 

of  tibia   185 

Compression  of  brain   . . .  .210 

Concussion  of  brain 210 

Convulsions    214 

—  of  infants   214 

—  uraemic  215 

Copper  acetate  poisoning  ..204 

—  sulphate  poisoning 204 

Corrosive  poisons 194 

—  sublimate  poisoning  ....204 
Crayons,  poisonous  ...200,  204 
Cyanide   of  potassium   poi- 
soning   198 

Cytisine  poisoning 204 

Deadly  nightshade  poison- 
ing   200 

Death,  appearances  accom- 
panying in  asphyxia  . .  193 

Demulcents  in  poisoning  ..196 

Digital  compression  for 
hemorrhage  178 


PAGE 

Dislocations    184 

Draw  sheet,  to  put  on 220 

Drowning,  treatment  of  ap- 
parent death  from 190 

—  what   things    to   prepare 

in  case  of 222 

Ears,    removal    of    foreign 

bodies  from   218 

Electricity   217 

Emetics,  caution  as  to 195 

—  for  use  in  cases  of  poi- 

soning   195 

Epileptic  fits 213 

Ergot  of  rye  poisoning 203 

Ergotine  poisoning  203 

Ether  poisoning 203 

Eyes,  removal  of  foreign 

body  from 218 

Fainting 208 

Fire,  to  extinguish  in  clothes.2i6 

Fits   213 

Fly  papers,  poisonous 200 

Foreign  bodies,  removal  of. 218 
Fracture-bed,  essentials  of. 214 
Fracture,    immediate    treat- 
ment of  a  compound.  .187 

—  signs  of 186 

Fractures    185 

—  repair  of  185 

Freezing,  treatment  of 212 

Fungi  poisoning  203 

—  fly  poisoning 203 

Gases,  carbonic  acid  poison- 
ing   203 

oxide  poisoning 203 

—  coal  gas  poisoning 203 

—  laughing  gas  poisoning.  .203 


INDEX. 


327 


PAGE 

Gases,  marsh  gas  poisoning.2O3 

—  sewer  gas  poisoning  . . .  .203 
Glacial   acetic   acid   poison- 
ing      197 

Greenstick       fracture,       of 
radius  185 

Hemorrhage  175 

—  arterial 175,  177 

—  articles  required  for  con- 

trolling     222 

—  capillary 175 

—  causes  of 175 

—  definition  of  175 

—  "  first  aid  "  for 177 

—  immediate  treatment  . . .  175 

—  internal 178 

—  situation  of 175 

—  varieties  of  175 

—  venous 175,  176 

Hair  dyes  poisoning 204 

Hanging,  asphyxia  from  . . .  193 

Henbane  poisoning 203 

Holly  berries  poisoning 203 

Hydrochloric  acid  poisoning.  197 
Hydrocyanic  acid  poisoning.  198 
Hyoscyamine  poisoning  . . .  .203 
Hysterical  fits   214 

Ices,  cheap  poisonous 200 

Infants,  convulsions  of 214 

Insects,  stings  of 183 

Insensibility    208 

—  test  for 212 

Intoxication,  alcoholic 211 

Iodine  poisoning  204 

lodoform    poisoning    204 

Irritant  poisons  194 

Laburnum  poisoning  204 


PAGE 

Laudanum  poisoning 206 

Laurel  water  poisoning 198 

Lead  poisoning  204 

—  acetate  poisoning   204 

—  paint  poisoning  204 

—  sugar  of,  poisoning  ....204 

—  white,  poisoning   204 

Lightning,  effects  of 217 

Lime,  caustic,  poisoning  . . .  199 

—  quick,  poisoning  199 

Liqueurs  poisoning   205 

Lungs,  bleeding  from  179 

Matches  poisoning 206 

Mercury,   acid  nitrate,   poi- 
soning   204 

—  perchloride  poisoning  .  .204 

—  red  oxide  of,  poisoning.  .204 

Monkshood  poisoning 198 

Morphine  poisoning   206 

Muriatic  poisoning 197 

Mushrooms,  poisonous 203 

Mussels,  poisonous   205 

Narcotic  poisons 194 

Neuraline  poisoning   198 

Nicotine  poisoning 207 

Nitrate  of  silver  poisoning.  .201 

Nitric  acid  poisoning 197 

Nitro-benzol  poisoning 205 

Nitrous  oxide  gas  poisoning.2O5 
Nose  bleeding 180 

—  removal  of  foreign  body 

from    218 

Oil  of  almonds  poisoning  . .  198 

vitriol  poisoning 107 

Opium  tincture  poisoning  .  .206 

—  wine  of,  poisoning 206 

Oxalic  acid  poisoning 197 


328 


PASTORAL   MEDICINE. 


PAGE 

Paraffin  oil  poisoning 206 

Paregoric  poisoning 206 

Peach  kernels  poisoning  . . .  198 

Phenol  poisoning 197 

Phosphorus  poisoning 206 

Poisoning,  classification  of.  .194 
Poisoning,  definition  of  ....  194 

—  depression  from 195 

—  evidence  of 194 

—  general  treatment  for  . .  195 

—  how  to  act  in 195 

—  immediate  treatment  of.  .194 

—  pain,  relief  of,  in 195 

—  shock  from 195 

—  unknown,  general   treat- 

ment    195 

Poisonous  fish  and  meat  .  ..205 
Poisons,  acetate  of  copper.. 202 
lead  204 

—  acids  197 

acetic    197 

arsenious   200 

carbolic    197 

carbonic  203 

hydrochloric  197 

hydrocyanic    198 

nitric     197 

oxalic   197 

prussic    198 

sulphuric   197 

—  aconite   198 

liniment  of  198 

—  ether   203 

—  after   damp    203 

—  alcohol   199 

—  alkalies  199 

ammonia   199 

caustic    199 

liquid    199 

liniment  199 


PAGE 

Poisons,  alkalies,  lime 199 

caustic    199 

quick 199 

potash 199 

caustic    199 

soda 199 

caustic    199 

—  almond  flavor 198 

oil  198,  205 

—  ammonia    199 

—  aniline  dyes   205 

—  animal  alkaloids 205 

—  antimony   ; 199 

tartarated    199 

—  antimonial  wine 199 

—  aperients  for — 

castor   oil,    sulphate   of 
magnesia  (Epsom  salts)  196 

—  aqua  fortis   197 

tofana  200 

—  arnica  204 

—  aromatic  vinegar 197 

—  arsenic   200 

white 200 

—  arsenious  acid  200 

—  atropine   200 

—  bean,  St.  Ignatius'  205 

—  belladonna 200 

—  benzol    205 

—  berries,   holly   203 

—  bites,     mad     dog     and 

snake    183 

—  bitter  almonds    198,  205 

—  blister  beetle 201 

fluid 201 

—  blue  rocket  198 

stone  202 

vitriol   202 

—  brandy    199 

—  camphene 207 


INDEX. 


3*9 


PAGE 

Poisons,  camphor 201 

essence  201 

liniment  201 

spirits  201 

—  cantharides  201 

—  carbolic  acid 197 

—  carbonic  acid  203 

gas 203 

oxide  gas 203 

—  caustic  ammonia 109 

lime 199 

lunar  201 

potash 199 

soda 199 

—  chalks,  French  200,  204 

—  charcoal  fumes 203 

—  choral  201 

hydrate 201 

syrup 201 

—  chloride  of  antimony 199 

lime 201 

—  chlorine  gas  201 

—  chlorodyne    206 

—  chloroform,  inhaled 202 

swallowed   202 

-  choke  damp 203 

—  coal  gas  203 

—  codeine 206 

—  compound  camphor  lini- 

ment     201 

—  copper •  -2O2 

acetate    202 

sulphate   202 

—  corrosive  acids 197 

sublimate  204 

—  corrosives    IQ4 

—  crayons   2°°,  204 

—  croton  oil 2O2 

—  cyanide  of  potassium  . .  198 

—  cytisine    2°4 


PAGE 
Poisons,  deadly  nightshade .  200 

—  demulcents  for — 

arrowroot,  barley  water, 
eggs  (raw),  flour  and 
water,  gruel,  linseed  tea, 
milk,  olive  oil 196 

—  dog  bites  184 

—  emerald  green  200 

—  emetics  for — 

ipecacuanha  powder,  ip- 
ecacuanha wine,  mus- 
tard, salt,  sulphate  of 
zinc,  tepid  water 195 

—  enema  for — 

beef  tea,  spirits,  tea  (or 
coffee)  196 

—  ergot  of  rye 203 

—  ergotine   203 

—  essence  of  camphor 201 

henbane   203 

—  ether,  inhaled 203 

—  fish  poisonous 205 

—  fly  fungi 203 

papers 200 

—  French  chalks 200,  204 

—  friend      and      soothing 

syrup,   mother's    206 

—  fruits,  tinned   200 

—  fungi    203 

—  gases  203 

acetylene    203 

after  damp 203 

carbonic  acid 203 

oxide 203 

charcoal  fumes 203 

chlorine   201 

choke  damp 203 

coal  gas  203 

marsh  gas 203 

nitrous  oxide    205 


33° 


PASTORAL   MEDICINE. 


PAGE 

Poisons,  gases,  sewer  gas.  .203 

—  gin 199 

—  glacial  acetic  acid 197 

—  hair  dyes 204 

—  hartshorn 199 

—  henbane   203 

—  holly  berries 203 

—  hydrate  of  chloral 201 

—  hydrochloric  acid   197 

—  hydrocyanic   acid    198 

—  hyoscyamine  203 

—  hyoscyamus    203 

—  ices,  cheap 200 

—  Ignatius',  St.,  bean 205 

—  insect  stings 183 

—  iodine   204 

—  iodoform   204 

—  irritants   194 

—  laburnum 204 

—  laudanum    206 

—  laughing  gas 205 

—  laurel  water  198 

—  lead  204 

acetate    204 

hair  dyes  204 

paint   204 

sugar  of 204 

white    204 

—  lime,  caustic 199 

quick 199 

—  liniment,  aconite 198 

ammonia    199 

belladonna    200 

camphor 201 

—  liqueurs    205 

—  lunar,  caustic  201 

—  mad  dog  bites 184 

—  matches    206 

—  mercury   204 

acid  nitrate 204 


PAGE 
Poisons,    mercury,   perchlo- 

ride    204 

red  oxide 204 

red  and  white  precipi- 
tate     204 

—  methylated  spirit 199 

—  mineral  green 200 

—  monkshood   198 

—  morphine    206 

—  mother's       friend       and 

soothing  syrup 206 

—  muriatic  acid  197 

—  mushrooms   203 

—  mussels 205 

—  narcotic    194 

—  narcotic  irritants    194 

—  neuraline   198 

—  nicotine    207 

—  nightshade,  deadly  200 

—  nitrate  of  silver 201 

—  nitric  acid  197 

—  nitro-benzine    205 

—  nitro-benzol    205 

—  nitrous  oxide  gas 205 

—  nux  vomica    206 

—  oil  of  almonds 198 

bitter 198 

turpentine    207 

vitriol    197 

—  opium  206 

—  oxalic  acid 197 

—  oxide  of  mercury 204 

—  paint,   lead    204 

—  paraffin  oil    206 

—  paregoric   206 

—  paste  for  rats 200,  206 

—  peach  kernels  198 

—  perchloride  of  mercury.  .204 

—  phenol 197 

—  phosphorus  206 


INDEX. 


331 


PAGE 

Poisons,  phosphorous  paste.2oo 

—  poisonous  fish 205 

meat    205 

mushrooms   203 

—  pomades,  as  205 

-  poppies,  syrup  of 206 

—  potassium  cyanide 198 

—  proof  spirit 199 

—  prussic  acid 198 

—  ptomaines    205 

—  quick  lime 199 

—  rat  paste 200,  206 

poison    206 

—  rectified  spirits 199 

—  red  oxide  of  mercury  . .  .204 
precipitate   204 

—  rum  199 

—  rye,  ergot  of 203 

—  St.  Ignatius'  bean 205 

—  salts  of  lemon 19? 

sorrel    197 

—  sedatives   for   (see  "  de- 

mulcents "  above)    196 

—  sewer  gas  203 

—  silver  nitrate   201 

—  snake  bite 184 

—  soda,  caustic   199 

—  soothing  syrup,  mother's.2o6 

—  Spanish  fly  201 

—  spirit,  methylated  199 

proof    199 

rectified 199 

—  spirits  of  camphor 201 

hartshorn 199 

salt    197 

turpentine   207 

—  stimulants  for — 

beef  tea,  coffee  (or  tea), 
cold  and  hot  douches 
alternately,  sal  volatile 


PAGE 

(aromatic  spirits  of  am- 
monia), spirits  (brandy 

or  whisky)   196 

Poisons,  stings  of  insects..  183 

—  strong  acids  197 

—  strychnine  205 

—  sugar  of  lead 204 

—  sulphate  of  copper 202 

—  sulphuric  acid   197 

—  sweetmeats  as 205 

—  syrup  of  chloral  201 

poppies    206 

soothing 206 

—  tartar  emetic   199 

—  tartarated  antimony    ...  199 

—  tin   207 

impurities  of  200 

—  tincture  of  opium 206 

—  tinned  fruits 200 

—  tobacco 207 

—  turpentine    207 

oil  of  207 

spirits  of 207 

—  turps  207 

—  verdigris    202 

—  vermin  killer  .  .200,  205,  206 

—  Vienna  green  200 

—  vitriol,  blue 202 

oil  of  197 

white 207 

—  wall  papers 200 

—  whisky  199 

—  white  arsenic  200 

lead  204 

precipitate  204 

vitriol  207 

—  wine  of  antimony 199 

opium  206 

—  zinc   207 

chloride  207 


332 


PASTORAL   MEDICINE 


PAGE 

Poisons,  sulphate  207 

Pomades,  poisonous 205 

Potash  caustic  poisoning  . .  199 
Poultices  and  fomentations  222 
Precipitate,  red,  poisoning. 204 

—  white,  poisoning  204 

Preparation  of  sick  room  .  .219 
Prussic  acid  poisoning  ....  198 
Ptomaine  poisoning 205 

Quick  lime  poisoning 199 

Radial,  fracture  of 133 

Rat  paste  poisoning  .  .200,  206 
Respiration,  artificial 187 

Salt,  common  for  wounds.  182 
Salts  of  lemon  poisoning  . .  197 

sorrel  poisoning   . . .  .197 

Scalds,  immediate  treatment 

of 215 

Sedatives  in  poisoning 196 

Shock  209 

—  from  burns  215 

Sick  room,  selection  of  ...  .219 

Snake  bites 183 

Soda  caustic  poisoning 199 

Soothing  syrup  poisoning  .  .206 

Spanish  fly  poisoning 201 

Spirits  (See  Poisons) 

Sprains 184 

St.  Ignatius'  bean  poisoning. 205 
Stimulants      in      poisoning 

cases  196 

Stings  of  insects 183 

Strangulation,  asphyxia 

from  193 

Strychnine  poisoning 205 

Styptics  176 

Sulphuric  acid  poisoning  . .  197 
Sunstroke  .  ..211 


PAGE 

Sweetmeats,  poisonous 205 

Syncope    178,  208 

Syrup  of  poppies  poisoning .  206 

Tin,  salts  of,  poisoning  . . .  207 
Tinned  fruits  poisoning  . . .  .200 

Tobacco  poisoning  207 

Transportation    of    injured 

person  186,  219 

Turpentine  poisoning 207 

Unconsciousness,    action    in 

case  of  211 

Uraemic  convulsions   215 

Varicose  vein,  how  to  treat 
a  burst  176 

Verdigris   poisoning    202 

Vermin  killer  poison- 
ing  200,  205 

Vienna  emerald  green  poi- 
soning   200 

Vitriol,  blue,  poisoning  ....202 

—  white,  poisoning 207 

Vomiting  of  blood  179 

Wounds,  bullet  181 

—  clean  cut 181 

—  contused    183 

—  definition  of  180 

—  immediate  treatment  of. .  181 

—  incised    182 

—  lacerated  181,  183 

—  poisoned  181,  183 

—  punctured    183 

—  simple    180 

—  stab  181 

—  to  cleanse 181 

dress 182 

Zinc,  chloride  of,  poison- 
ing   207 


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